ion: cat Pain Scale: 110 ' Dental Prostheses at Intake: Yes No Type: Age: Comfaion: Canal 47 0: 0 4r eEtsa etV /71 / Vat' r-c(4 SS/ on Olo Sertbe— 1.4,_..Xe—c C.-N, e4 or Cayt4-iit 1 OkS6.14e4 intra-cral Photos Takerc Yes 0 Radiographs Taken: (Document findings on MO encounter) Yes No .