| Patient | Octavia Needsortho | ||
| Date of birth | June 1, 2007 | Sex | Female |
| Contact info | Primary Home: 555 Home Street Fairfax, VA 22031, US Tel: +1(555)555-0001 |
Patient IDs | 111223333 2.16.840.1.113883.4.1 |
| Document Id | 45b48227-e792-4c98-a92d-b03ffac4d3ae |
| Document Created: | August 1, 2018, 13:00, PST |
| Healthcare service | Comprehensive orthodontic treatment of the adolescent dentition from January 1, 2018 to August 1, 2018 | ||
| Performer (primary care physician) | Olga Orthodontist, DMD of Fairfax Orthodontic Care | ||
| Author | Olga Orthodontist, DMD |
| Contact info | Work Place: 12345 Main Street Fairfax, VA 22031, US Tel: +1(555)555-0002 |
| Observation | Value |
|---|---|
| Orthodontic Narrative | 11 year old female with skeletal and dental class II malocclusion |
| Orthodontic Habits | Reported thumb sucking habit until 3 years ago |
| Traumatic Deviations | N/A |
| Asymmetry of Lower Face | Symmetric, but displays a long lower face height |
| Condylar Abnormality | N/A |
| Craniofacial Anomalies | N/A |
| Orthognathic Surgery Possibility | Possible, but after growth cessation |
| Airway Problems | N/A |
| Treatment Precondition | N/A |
| Diagnostic Feature | Deep Impinging Overbite with destruction of soft tissue |
| Diagnostic Feature | Lip incompetence due to horizontal overbite |
| Diagnostic Feature | Bimaxillary protrusion |
| Craniofacial Anomaly | N/A |
| Dental Abnormality | N/A |
| Benefits Requested | Comprehensive Treatment |
| Dentition Stage | Mixed (transitional) |
| Overjet | 10mm |
| Overbite | 10mm |
| Arch Crowding | Anterior Maxilla - 4mm |
| Arch Crowding | Anterior Mandible - 5mm |
| Labiolingual Deviation | 6mm |
| Observation | Value |
|---|---|
| Salzmann Index | 32 |
| Posterior Inter-Arch Deviation | Tooth 6 - Anterior Deviation |
| Posterior Inter-Arch Deviation | Tooth 5 - Anterior Deviation |
| Posterior Inter-Arch Deviation | Tooth 4 - Anterior Deviation |
| Posterior Inter-Arch Deviation | Tooth 3 - Anterior Deviation |
| Posterior Inter-Arch Deviation | Tooth 11 - Anterior Deviation |
| Posterior Inter-Arch Deviation | Tooth 12 - Anterior Deviation |
| Posterior Inter-Arch Deviation | Tooth 13 - Anterior Deviation |
| Posterior Inter-Arch Deviation | Tooth 14 - Anterior Deviation |
| Overbite Teeth Count | 4 |
| Overjet Teeth Count | 4 |
| Rotated Teeth Count | Anterior Maxilla - 2 |
| Rotated Teeth Count | Anterior Mandible - 4 |
| Crowded Teeth Count | Anterior Maxilla - 2 |
| Crowded Teeth Count | Anterior Mandible - 4 |
| Document maintained by | Fairfax Orthodontic Care |
| Contact info | Work Place: 12345 Main Street Fairfax, VA 22031, US Tel: +1(555)555-0002 |
| Assigned entity | Tommy Toothman |
| Contact info | Work Place: 12345 Main Street Fairfax, VA 22031, US Tel: +1(555)555-0002 |
| Legal authenticator | Olga Orthodontist, DMD signed at August 1, 2018, 13:00, PST |
| Contact info | Work Place: 12345 Main Street Fairfax, VA 22031, US Tel: +1(555)555-0002 |