OFFICE SUPPLIES CLINICAL FORMS Back Patient Registration (369-0023) Recall Examination (369-0025) Vertical ANATOMIC EXAM RECORD FORM * The front of this 2-sided form features " 1-32 " numbering, " a-t " lettering, and an area to summarize patient history * Choose from 2 formats: vertical for file folders or horizontal for file envelopes * 81 ⁄2 " W x 11 " H vertical * 11 " W x 81 Specify: Vertical ⁄2 " H horizontal Record Form........................................................250 per Pkg. (367-4678) Horizontal (367-3431) Front Progress Notes, 2-Sided (369-0026) Health History, 2-Sided (369-0029) EXAM/ACCOUNT RECORD FORM * Tooth charts include " 1-32 " and " 8-1/1-8 " adult numbering and " a-t " and " I-V/A-E " primary lettering * Front has areas for medical/dental history and treatment planning * 81 Back Front ⁄2 " x 11 " vertical (367-7525).................. 250 per Pkg. Treatment Plan with Chart (369-0028) DENTAL CLINICAL FORMS * Maintain accurate charting and notes * Printed on durable stock * Formatted with vertical 2-hole punch for easy filing * 81 ⁄2 x 11 " Clinical Forms...................................................... 100 per Pkg. 5 Pkg.@ Specify: Patient Registration Recall Examination Progress Notes, 2-Sided Treatment Plan with Chart Health History, 2-Sided (369-0023) (369-0025) (369-0026) (369-0028) (369-0029) For pricing information and/or to place an order, visit: www.henryscheindental.com EXAM RECORD TREATMENT NOTES (369-0035)..........................................................100 per Pkg. * 2-sided forms that allow for exam documentation * Printed in black ink * 81 ⁄2 " W x 11 " H vertical Section 36-69