n: Pain Scale: /la Dental Proseriesas at trttalek Yes No 119e: Age: ØØn: Ct.iclinzntit 4 2 rk. 02 65 / / -ter Co-.. ton Iriibka on big Serti-e• • l Ae./1 tar Cart...klitt5 010 Sa ukd t., In/fa-oral Photos Taken: Yes 0 Radiographs Taken: (Document findings on A80 encounter) Yes No

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