es at Intake: Yes No Type: Ate: Condition: Co 4O P ei wl R G2 SS i I ils- 1° r O,..Acn 4, ca tekte ctf1Ctic, : • Jr: 5 on Dip ~— or Ciryt.Q.-in / I, ica 4 05-e-A f-4 Intro-oral Photos Taken: Yea C Radiographs Takart (Document findings on MO encounter) Yes No . Instructed how le