Figure 2-23.Dental Treatment Form (EZ603A).
piecing together a treatment history of a particular
A medical alert, if present, is written in red ink at
the top of the EZ603A. All entries, except for the
medical alert, are made per MANMED chapter 6,
Section 13 through 15, in black ink. Complete the
patient identification box as indicated at the bottom
portion of the EZ603A.
REPORT OF MEDICAL EXAMINATION,
Frequently, you will have patients needing a dental
examination in conjunction with a medical physical.
The SF 88 (rev. 10-94) (figs. 2-24 (front) and 2-25
(back)) is used to record the findings of a dental
examination. Please note that this form replaces the
old SF 88 (rev. 10-75). Only boxes 18 (old box 44), 43
(old box 74), and 50 (old box 81) will require dental
entries. Although this form is self-explanatory and
quite simple to complete, it is important that the entries
you make are neat and accurate in every detail. Next,
boxes 18, 43, and 50 of the SF 88 are discussed.
Chart the conditions noted by the dentist. The
charting symbols are printed on the upper portion of