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COMPREHENSIVE ASSESSMENT |
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DATA COLLECTION |
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| NAME |
Benavides, |
Mark |
Date: |
18-Aug-2001 |
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| Occupation: |
Dentist |
DOB |
4-Aug-1955 |
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Age: |
47 Years |
| Limited or Comprehensive Exam: |
Comprehensive |
| 1: MEDICAL CONSIDERATIONS |
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| Anesthetic Preference: |
Local-; |
| Allergies : |
penicillin-PenVK; to other medications-Sulfa; |
| Significant Findings : |
Heart Murmer-Mitral Valve Prolapse; |
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| Medication Noted |
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| Pre-Medicate: |
No- |
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| Referral/Consult |
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| 2: DENTAL HISTORY |
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| Previous Dentist: |
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Marquette University Dental Clinic |
How Long? |
17 years |
| Most Recent Dental Exam: |
1-Jan-1992 |
| Most Recent Dental Treatment: |
1-Jan-1992 |
| Most Recent Dental Xray |
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1-Jan-1997 |
| How Often Do You Have Your Teeth Cleaned? |
6 mo. |
| Significant Event |
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Orthodontics Twice, Orthognathic Surgery Once |
| Referred By |
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Self |
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| 3: IMMEDIATE DENTAL CONCERN: |
Comprehensive Care |
| Additional Dental Concerns: |
Esthetics |
| Oral Image: |
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Function |
| Motivation Level: |
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High |
| 4:PERSONALITY STYLE - DISC |
Amiable S |
| 5: DENTAL TYPE |
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Cooperative |
| 6: PHOTOGRAPHIC DOCUMENTATION |
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| Polaroid: |
None |
| 35mm: |
Completed |
| Digital: |
Completed |
| IntraOral |
None |
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