3 Z! 3 2- 9 Head & Neck / Soft Tissue: D: ?lc I masorficatIon: irft Pain Scale: 11O ' Dental Prostheses at Intake: Yes No Typo: Age: Concrfilorc and h:5, ‘,... l tc, iczc.,,:v " R Q SS/ on 09 Seikbe, 1 4,—../-er C—s at ca t0..:1A5 olastfik4 Intra-oral Photos Taken: Yes 0 Radiograph