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Figure 2-23.—Dental Treatment Form (EZ603A) | Up
Dental Technican, Volume 2 - Dentist training manual for military dentists | Next
CONSULTATION SHEET, SF 513 |
Figure 2-24.—Report of Medical Examination, SF 88, (front) Box 18.
box 18. Use these symbols to chart the lower portion of
this box. Box 18 also contains space for the dentist's
"Remarks and Additional Dental Defects and
Diseases." In this space, type, print, or stamp the type
of dental exam, dental classification, and qualified
"YES" or "NO."
Box 43
Include here a summary of the patient's dental
defects and the dentist's diagnosis. Since the summary
refers to the items noted in box 18 (the dental section of
the report), mark in the summary #18 and list defects
and diagnosis.
Box 50
Type, print or stamp the examining dentist's name,
rank, DC, and USN (or USNR) or civilian title
(DDS/DMD) if a contract dentist performs the
examination. A dentist or physician signs his or her
signature in box 50.
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