Free template
Filling note template
For a direct restoration such as a filling: the tooth, anaesthetic, the steps of the procedure and the material used, finishing with post-operative advice. Works for most direct operative appointments, not only composite fillings.
PATIENT ATTENDED FOR
Treatment:
Tooth / Teeth:
History:
Assisted by:
MEDICAL HISTORY
Medical History:
Allergies:
Medications:
PMS Updated:
SPECIAL TESTS
Special Tests:
CONSENT
Discussion:
Estimate Discussed:
Risks and benefits discussed:
Verbal consent after discussion of treatment:
PROCEDURE
Local Anaesthetic:
Isolation:
Cavity Preparation:
Matrix:
Matrix Accessories:
Bonding:
Material:
Shade:
Occlusion:
POST OPERATIVE DISCUSSION
Post-op Advice:
Medication Dispensed / Prescribed:
Adverse Reactions / Complications:
Next Visit:
GDC standard 4.1 expects a patient's clinical record to be made as the appointment happens, and to be accurate and complete.
How Assist helps
Assist fills this in for you.
Assist records the appointment and drafts a note in this structure for the dentist to review and sign off. It writes up what was said in the room, and you check every line before it goes in the record.
28 days free. No card required.
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