Case Presentation 1

D3 Case Presentation
Full Name

First NameLast Name
E-mail
Doc #
Patient windent #
Date of submission
Date of presentation
SECTION 1 INTRODUCTION & HISTORY
INTRODUCTION

Biographic Data
1-1. age - in years
1-2. race
if other, describe
1-3. gender
Occupation & Socioeconomic Profile
1-4. occupation
1-5. employment
1-6. insurance
HISTORY

CC, HPI, Medical Conditions
1-7. chief complaint (in patient’s own words)
1-8. history of present illness (elaborate on the chief complaint)
1-9. behavioral profile (cooperative, hostile, etc.)
1-10. significant medical conditions
Medications, Summary of Medical Status & Medical Risk
1-11. current medications - drug name/dose/frequency
1-12. summary of medical status
1-13. medical risk
1-14. medical consult
if yes , add reply from MD & recommendations
Dental History
1-15. last dental exam
1-16. history of dental care
1-17. pain or bleeding present
if yes, describe
1-18. problems w/previous dental care
if yes, describe
1-19. anxiety or fear
if yes, describe
Should be Empty: