General note
0140, 0220, 7010, ext...


Reviewed HHx (Indicate any existing conditions/positive health findings i.e.: allergies, HTN, Diabetes, Infectious diseases, Medications) or Patient denies history of asthma, allergies, CVD, DM, ID, seizure disorders, psychiatric disorders, surgeries, hospitalizations, medications.

BP xx/xx mmHg LASit/RASit

Radiographs: 1 PA/PAN/BW

Tooth #xx

Discussed with patient all treatment options, patient choose extraction treatment. Patient referred to O.S. for extraction.

O.S. appointment: date and time

Rx: none/prescription

Patient was advised about the need and importance of comprehensive dental care.

Chief Complaint

xx yo AA/CAU/Asian/Hisp M/F presents to emergency clinic.

CC: "In patient’s own words" 

HPI: Expand on the CC
Onset: Patient states pain began a week ago
Location: Patient states upper/lower right/left front/back tooth/teeth 
Duration: Patient states pain is intermittent/spontaneous/constant
Severity:  Patient states xx on a scale of 1-10 with 10 being the worst pain
Character: Patient states radiating/throbbing/dull pain on entire right/left side of the face or localized pain.
Patient states this keeps him/her awake at night
Aggravating factors: Patient states heat, cold, air, palpation, mastication
Relieving factors: Patient states meds/home remedies will help relieve the pain
Associated factors: fever/swelling/exudates)

Clinical Findings
Intraoral exam affected area(s):
Percussion: (+-)
Palpation: (+-)
Cold: (+-) NL/L 
Mobility: None or Miller Class I/II/III
Probing depths: WNL
Furcation involvement: None or Glickman Class I/II/III/IV

Options and Proposed Emergency Treatment
Discussed with patient all tx options including:
1. Pain management
2. Extraction of #xx
3. GPD today followed by RCT, CL, PFM crown

Patient chooses option #2.  Patient referred to O.S. for extraction.