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Case history and examination sheet for oral

Name of
patient.
Age.. date
phone.
Sex..
occupation
address

Chief complain

History of present illness

...
Examination of oral cavity
M

CR

Case history and examination sheet for oral

Medical history ..,

Family and social history

..
General examination

..
Local examination

..
Intra oral

.............

Differential diagnosis

Case history and examination sheet for oral

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