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Last Name
EVANGELISTA
First Name
KAYESHA PATRICE
Middle Name
R
Birthdate
September 24, 2013
Age
12
Street
UNIT 309 EUPHRATES BLDG.
Barangay
MANILA RIVERCITY,STA.ANA
City
MANILA
Country
PHILIPPINES
Zip Code
123
Contact number
09152450400
Procedure
10/04/25 OP 3D SCAN DP FOR ORTHO BAL.2,499.50 ***FOR LC 16(O,L) 36,46 (O,B) 10/10/25 install brace - MBT 0.22 14 NITI U/L Occlusal pads on #36 & #46 Lip tie - level 3 Tongue tie - level 4 11/8/25 Adjustment reattach #36, 35 12/10/2025 Adjustment 16 NiTi U/L New bracket attachment - #35, #45 Molar band #36, #46 01/10/26 adjustment 3/7/26 adj. same wire 16 niti U|L Re-attached #16 Fox 3.5
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Retain Record
Yes