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Click ‘Get Form’ to open the DENTAL HEALTH RECORD in the editor.
Begin by entering the child's name and date of birth (DOB) at the top of the form. Select the appropriate gender and center.
Fill in the parent or guardian's name, phone number, and address to ensure accurate contact information.
Provide your authorization by signing in the designated area, confirming that you allow qualified individuals to exchange information about your child.
In the table provided, list any recommended services along with details such as tooth number, surfaces treated, date of service, and a description of services performed.
Indicate any oral conditions before treatment using the diagram provided. Mark missing teeth, decay, or filled areas as applicable.
Complete the CHILD ORAL HEALTH SUMMARY section by checking off dental needs and problems noted. Specify if all planned treatments are complete or not.
Finally, return completed forms to the parent/guardian or send them to SETA Head Start as instructed at the bottom of the form.
Start filling out your DENTAL HEALTH RECORD online for free today!
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The dental record is your official document that details all diagnostic information, health history, clinical notes, treatment performed, and patient-related communications that took place in the practice.
What does a dental record look like?
Dental records, also known as patient charts, are made up of the recorded information regarding your medical history, diagnostic information, clinical notes, patient-doctor communication, consent to treatment documents and treatment notes, as the American Dental Association (ADA) explains.
How does a dental record work?
What happens during a dental check-up? At each check-up, your dentist should: examine your teeth, gums and mouth. ask about your general health and any problems youve had with your teeth, mouth or gums since your last visit. ask about, and give you advice on, your diet, smoking and alcohol use, and teeth-cleaning
What is a dental health check?
A dental record is the detailed document of the history of the illness, physical examination, diagnosis, treatment, and management of a patient. Dental professionals are compelled by law to produce and maintain adequate patient records.
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