Free template
Recall examination note template
For a routine check-up with an existing patient: a lean structure covering the examination findings, periodontal screening and a plan, without repeating a full social and dental history. It keeps a routine note short without dropping the essentials.
PRESENTING COMPLAINT
Presenting Complaint:
Assisted by:
MEDICAL HISTORY
Medical History:
Allergies:
Medications:
PMS Updated:
DENTAL HISTORY
Toothbrushing:
Interdental Cleaning:
Diet:
Attendance:
SOCIAL HISTORY
Smoking:
Cigarettes per Day:
Years of Smoking:
Previous Cigarettes per Day:
Previous Years of Smoking:
Vaping:
Vaping Details:
Alcohol:
Stress:
EXTRAORAL EXAMINATION
Temporomandibular Joint:
Muscles of Mastication:
Lymph Nodes:
Salivary Glands:
Facial Symmetry:
Lips:
INTRAORAL: SOFT TISSUE
Mucosa:
Gingivae:
Tongue:
Palate:
Floor of Mouth:
Oropharynx:
INTRAORAL: HARD TISSUE
Dentition:
Restorations:
Missing Teeth:
Oral Hygiene:
Tooth Wear:
SCREENING & TESTS
Basic Periodontal Examination (BPE):
SPECIAL TESTS
Special Tests:
RADIOGRAPHS
Type:
Radiograph Status:
Justification:
Quality Grade:
Caries:
Bone Levels:
Other Findings:
DIAGNOSES
Diagnosis:
Periodontal Diagnosis:
Differential Diagnosis:
RISK ASSESSMENT
Caries Risk:
Periodontal Risk:
Tooth Surface Loss Risk:
Oral Cancer Risk:
TREATMENT PLAN
Plan:
Estimate Discussed:
Prevention:
Next Examination:
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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