DOJ-OGR-00024179.pdf

BP-A0618 JUN 16 U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS A&O DENTAL EXAMINATION (Initial Clinical Dental Findings) Occlusion: Oral Hygiene: Good Fair Poor CPITN: 3 2 3 3 2 3 Head & Neck / Soft Tissue: D: M: F: 14 Classification: CL II Pain Scale: /10 Dental Prostheses at Intake: Yes No Type: Age: Condition: Intra-oral Photos Taken: Yes No Instructed how to obtain urgent and non-urgent dental care: Yes No Treatment Priorities: None: Non-urgent: non-urgent Urgent: Referred to Sick Call: Radiographs authorized: PAs: BWs: Panrex: Prophylaxis authorized: (Approval valid 18 months from examination date) Yes No Patient Name: Epstein, Jeffrey E Register Number: 76318-054 Institution: MCC NEW YORK Dentist Signature: (b)(6), (b)(7)(C) DDS Date: 7-26-19 Signature Block/Stamp: (b)(6), (b)(7)(C) DDS Chief Dental Officer MCC New York Comments: advanced periodontitis Gingival recession observed. Lower anterior crowding observed Radiographs Taken: (Document findings on A&O encounter) Yes No PDF Prescribed by P6400 Replaces BP-A0618 of JUN 10 DOJ-OGR-00024179