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. –
2
5. HISTORY
Past Medical History –
Past Dental History –
Family History –
Personal History –
Drug History -
Pre-natal History Birth History –
Post Natal History –
5
6. 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. -
6