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Page 2668 BP-A0618 A&O DENTAL EXAMINATION JUN 16 (Initial Clinical Dental Findings) U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS Occlusion: | Oral Hygiene: Fair 7 . | 2] US | Classification: ae 2 3 45 6 7 8B 9 1011 1213 14 15 16 232 31°30 29 28 27 2625 2423 22 2120 19: 18 17 Dental Prostheses at Intake: mit f we | i OhsespUed. Type: Age: Later On Neh of ane observed Condition: Intra-oral Photos Taken: Radiographs Taken: (Document findings on A&O encounter) Yes Yes i) / Treatment Priorities: Non-urgent: Urgent: Referred to Sick Call: Se ee Radiographs authorized: | Prophylaxis authorized: Yes wf No PAs: (Approval valid 18 months from examination date) BWis: Panorex: Patient Name: Dentist Signature: 4 S aw 1) erseres MCC New York PDF Prescribed by P6400 ~ Replaces BP-A0618 of JUN 10 DOJ-OGR- 00026324