DOJ-OGR-00026085.pdf

--- Page 1 --- **Extracted Text:** **Page Header:** Page 2409 **Document Header:** BP-A0618 JUN 16 U.S. DEPARTMENT OF JUSTICE A&O DENTAL EXAMINATION (Initial Clinical Dental Findings) FEDERAL BUREAU OF PRISONS **Table 1:** | Occlusion: | Oral Hygiene: | Good | Fair | Poor | | --- | --- | --- | --- | --- | | CPITN: | 3 | 2 | 3 | | Head & Neck / Soft Tissue: | 3 | 2 | 3 | **Table 2:** | Dental Prostheses at Intake: | Comments: | | --- | --- | | Yes | advanced mod to moderate gingival recession observed. Lower anterior crowding observed. | | Type: | - | | Age: | - | | Condition: | - | | Intra-oral Photos Taken: | Radiographs Taken: (Document findings on A&O encounter) | | Yes | No | | Instructed how to obtain urgent and non-urgent dental care: | Yes: | No: | | Treatment Priorities: | None: | Urgent Referred to Sick Call: | | Radiographs authorized: | Prophylaxis authorized: | | PAs: | (Approval valid 18 months from examination date) | | BWs: | - | | Panorex: | - | **Patient Information:** Patient Name: Eastein, Jeffrey E Registration Number: 76318-054 Institution: MCC NEW YORK **Dentist Signature:** Signature Block/Stamp: DDS Date: 7-26-19 Chief Dental Officer: MCC New York **Handwritten Notes:** [No handwritten notes visible] **Footer:** Prescribed by P6400 Replaces BP-A0618 of JUN 10