7/6/96 Ped. Dent.
Dx Developmental Occ. Grooves (520.9) Tx OH fair, brushing needs improvement
Plaque score recorded
Occlusal sealants applied to teeth #3, 14, 19 and 30 using rubber dam isolation and topical anesthetic applied to gingiva
PICPFBx Pt. tolerated procedure well after dam was placed B3+ Rx Return for routine OHM/F/U q 6 mo. Card filled out and filed.
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Faculty Signature: ___________________ (necessary for all unlicensed providers)