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Page Title: Figure 2-23.—Dental Treatment Form (EZ603A)
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INSTRUCTIONS FOR COMPLETING THE BACK OF THE EZ603
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Dental Technican, Volume 2 - Dentist training manual for military dentists
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Figure 2-24.—Report of Medical Examination, SF 88, (front) Box 18

Figure 2-23.—Dental Treatment Form (EZ603A). piecing  together  a  treatment  history  of  a  particular tooth. 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, (SF 88) 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. Box 18 Chart  the  conditions  noted  by  the  dentist.  The charting  symbols  are  printed  on  the  upper  portion  of 2-23

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