Perio Chart Form PDF Details

In the realm of dental health, precise and comprehensive patient records are paramount for effective diagnosis, treatment planning, and follow-up care. The Perio Chart form stands as a crucial tool in this endeavor, meticulously detailing the periodontal health status of patients. It encompasses a range of critical indicators including, but not limited to, Clinical Attachment Loss (CAL), presence of Bleeding on Probing (BOP), Probing Depth (PD),Plaque Index (PI), and the state of calculus (Calc) formations. Notably, the form is structured to facilitate not just a one-time assessment but also to document changes over subsequent visits, segmented into pre-treatment, re-evaluation, and recall maintenance phases. This enables dental professionals to track the progression or improvement of a patient's periodontal condition over time. Moreover, the chart includes specific sections for recording the gingival margin (GM) status relative to the cementoenamel junction (CEJ), and any tooth mobility, providing a comprehensive view of oral health that informs strategic treatment decisions. With spaces dedicated to the patient's name, file number, and date of visit, along with a section for the supervisor’s signature, the Perio Chart form ensures both accountability and a standardized approach to periodontal care.

QuestionAnswer
Form NamePerio Chart Form
Form Length1 pages
Fillable?Yes
Fillable fields20
Avg. time to fill out4 min 15 sec
Other namesperiodontal chart, perio chart form, periodontal form, periodontal charting form

Form Preview Example

PERIODONTAL CHART

PATIENT NAME: ______________________

 

FILE NO.: ______________ DATE: __________

 

PRE-TREATMENT

 

RE-EVALUATION

 

RECALL MAINTENANCE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Diagnosis

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CAL, BOP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PD, PI, Calc

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CEJ-GM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FACIAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mobility

LINGUAL

CEJ-GM

PD, PI, Calc

CAL, BOP

CAL, BOP

PD, PI, Calc

CEJ-GM

LINGUAL

Mobility

FACIAL

CEJ-GM

PD, PI, Calc

CAL, BOP

Diagnosis

GM- Gingival Margin. CAL- Clinical Attachment Loss. CEJ- Cementoenamel Junction. PD- Probing Depth

Pl- Plaque, if presents put *. Calc- Calculus, if presents put *. BOP- Bleeding on probing, if presents put red

Plaque Index

Periodontal Diagnosis:

Bleeding Index

Supervisor’s Signature

How to Edit Perio Chart Form Online for Free

The filling out the downloadable perio chart is actually quick. Our team ensured our software is not difficult to work with and helps complete any sort of form in no time. Take a look at a couple of steps you'll want to take:

Step 1: Press the "Get Form Now" button to start out.

Step 2: Now you will be within the form edit page. You can add, transform, highlight, check, cross, include or erase fields or text.

Type in the content requested by the application to prepare the document.

periodontal chart spaces to consider

Include the essential details in the PD PI Calc, CAL BOP, CAL BOP, PD PI Calc, CEJGM, LINGUAL, Mobility, FACIAL, CEJGM, and PD PI Calc segment.

part 2 to finishing periodontal chart

In the PD PI Calc, CAL BOP Diagnosis, GM Gingival Margin CAL Clinical, Plaque Index, Bleeding Index, Periodontal Diagnosis, and Supervisors Signature segment, point out the crucial information.

part 3 to filling out periodontal chart

Step 3: Hit the Done button to save the document. At this point it is ready for upload to your gadget.

Step 4: Try to create as many duplicates of your form as you can to keep away from potential problems.

Watch Perio Chart Form Video Instruction

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