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tese pronta - (DDI) - UNIFESP

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Anexo 3 – Ficha do Paciente entregue aos examinadores da TC<br />

NOME: _____________________________________________________________________________<br />

NÚMERO: _________________ DATA: _____/_____/__________<br />

SEXO: ____________________ IDADE: _____________________<br />

EXAMINADOR : _____________________________________________<br />

TC (MAXILA)<br />

DENTE AS ES<br />

TC (MANDÍBULA)<br />

DENTE AI EI<br />

OBS: _______________________________________________________________________________<br />

____________________________________________________________________________________<br />

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