2. PRELIMNARY DATA
Patient name – Date –
Age / sex – O.P.No. –
Occupation – Religion –
Marital status – Blood group –
Date of birth – Socioeconomic status –
Address – Contact no. –
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3. PATIENT CHIEF COMPLAINT
HISTORY OF PRESENT ILLNESS
Past Medical History –
Past Dental History –
Family History –
Personal History –
Drug History -
Pre-natal History Birth History –
Post Natal History –
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4. GENERAL PHYSICAL EXAMINATION
Height – Weight –
Gait – Built –
Nourishment – Signs of Clubbing –
Pulse – Resp. Rate –
Blood Pressure- Temperature –
Body Mass Index – P.I.C.K.L.E. -
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