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Patient Info

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Last Name
Dela Cruz
First Name
Potty
Middle Name
N/A
Birthdate
November 16, 1985
Age
39
Street
3304
Barangay
ZAPOTE ST
City
MAKATI
Country
Philippines
Zip Code
Contact number
09453178818
Procedure
11/26/22- Oral Welness Pack./Deep Cleaning w/ Ozone/2 fillings/ 1 exo/xray/ 12/3/22- LC #37(o), 47(b), 47 (o) 12/10/22- Rct/ xray 12/25/22- 12/23/22-persurface 01/14/23- exo/ozone 02/07/23- Ints of Braces 03/00/23- 05/20/23-Ortho/U/L - same wire Coil spring b/w #31-#32 and #41- #42 06/10/23- Informed Consent/Ortho/UL same wire/Coil spring b/w #32-#33 & #42-#43/Reattach #11, #32 07/11/23- same wire 08/12/23- Reattached #15 16ss U/ 16ss L w/Loop/Class 3- elastic penguin 09/15/23- 18 ss U 16 ss L elastic/ New bracket #15/ elastic Fox 10/13/23 - 18 ss L - 18 ss U - close space on upper R - close space on lower 3x3 10/27/23- change chain Upper 11/23/23 Reattachment #16 BT 12/09/23- same wire Elastic Box Penguin 01/13/23- same wire/ class III elastic rabbit 02/20/24 same wire chain #24 to 26 chain # 13 to 16 chipmunk elastic to 35 03/23/24 Adj. same wire 04/20/24 chipmunk #13 to 14 to 43 chipmunk #15 to 16 to 44 same wire 05/21/24 ADj same wire 06/19/24 Adj same wire elastic rabbit 5oz. 07/30/24 same wire 08/17/24 chain lower sleeve wire on QIII 09/24/24 Adj same wire 10/19/24 adj 16x16ss U/L 11/23/24 same wire chain U 12/21/24 Adj same wire QI& QII-chipmunk box elastic chain L 01/18/25 adj same wire U chain L 16x16 SS L 02/15/25 adj box elastic rabbit 30z 03/15/25 adj same wire reattached 24/25 elastic 3's to 3's chipmunk 04/22/25 adj same wire reattached 24/25 elastic 3's to 3's chipmunk 05/24/25 Adj 16x22 L chipunk 3 to 3 06/21/25 same wire class III elastic chipmunk reattached #11,#42 07/ 19/25 adj, #25 reattach chipmunk elastic 07/26/25 reattached #25 09/13/25 SAME WIRE REATTACHED #25 10/11/25 SAME WIRE ELASTIC CHIPMUNK 5OZ
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Retain Record
Yes