Hamilton Clinical Chart/notes For Denture/partial Pre-Determination(S) Repairs, Additions And Relines Page 4

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Appendix A
Patient Name: _______________________________
Teeth currently missing: (X out entire tooth)
Teeth to be extracted, if any: (X out entire tooth)
Restorations needed:
Created Date: June 2013
4
Revision Date: October 2013

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