Document BP-A0618

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 --- PAGE BREAK --- Page 2400 BP-A0618 JUN 16 A&O DENTAL EXAMINATION (Initial Clinical Dental Findings) U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS Occlusion: Oral Hygiene: Good Fair Poor CPITN: 3 2 3 Head & Neck / Soft Tissue: 3 2 3 D: 0 Classification: CLI M: 1 F: 14 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: Urgent: Referred to Sick Call: Radiographs authorized: PAs: BWs: Panorex: Prophylaxis authorized: (Approval valid 18 months from examination date) Yes No Comments: advanced periodontitis. Gingival recession observed. Lower anterior crowding observed Radiographs Taken: (Document findings on A&O encounter) Yes No Patient Name: Epstein, Jeffrey E Register Number: 76318-054 Institution: MCC NEW YORK Date: 7-26-19 Dentist Signature: (b)(6); (b)(7)(C) DDS Signature Block/Stamp: (b)(6); (b)(7)(C) DDS. Chief Dental Officer MCC New York PDF Prescribed by P6400 Replaces BP-A0618 of JUN 10 DOJ-OGR-00026076 --- PAGE BREAK --- Page 2401 BP-A0618 JUN 16 A&O DENTAL EXAMINATION (Initial Clinical Dental Findings) U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS Occlusion: Oral Hygiene: Good Fair Poor CPITN: 3 2 3 Head & Neck / Soft Tissue: RIGHT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 LEFT D: 0 M: 1 F: 14 Classification: CLI 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: Urgent: Referred to Sick Call: Radiographs authorized: PAs: BWs: Panorex: Prophylaxis authorized: Yes No (Approval valid 18 months from examination date) Comments: much to moderate gingival recession observed. Lower anterior crowding observed Radiographs Taken: (Document findings on A&O encounter) Yes No Patient Name: Epstein, Jeffrey E Registrar Number: 76318-054 Institution: MCC NEW YORK Date: 7-26-19 Dentist Signature: (b)(6); (b)(7)(C) DDS Signature Block/Stamp: (b)(6); (b)(7)(C) DDS Chief Dental Officer MCC New York PDF Prescribed by P6400 Replaces BP-A0618 of JUN 10 DOJ-OGR-00026077 --- PAGE BREAK --- BP-A0618 JUN 16 A&O DENTAL EXAMINATION (Initial Clinical Dental Findings) U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS Occlusion: Oral Hygiene: Good Fair Poor CPITN: 3 2 3 3 2 3 Head & Neck / Soft Tissue: D: 0 M: F: 14 Classification: CL I Pain Scale: /10 Dental Prostheses at Intake: Yes No Type: Age: Condition: Comments: advanced need to moderate gingival recession observed. Lower anterior crowding observed Intra-oral Photos Taken: Yes No 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: Non-urgent: non-urgent Urgent: Referred to Sick Call: Radiographs authorized: Prophylaxis authorized: Yes No PAs: (Approval valid 18 months from examination date) BWs: Panorex: Patient Name: Epstein, Jeffrey E Registrar 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 PDF Prescribed by P6400 Replaces BP-A0618 of JUN 10 DOJ-OGR-00026082 --- PAGE BREAK --- Page 2409 BP-A0618 JUN 16 A&O DENTAL EXAMINATION (Initial Clinical Dental Findings) U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS Occlusion: Oral Hygiene: Good Fair Poor CPITN: 3 2 3 3 2 3 Head & Neck / Soft Tissue: D: 0 M: 1 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: BW's: Panorex: Prophylaxis authorized: Yes No (Approval valid 18 months from examination date) Comments: advanced periodontal disease observed recession observed Lower anterior crowding observed Radiographs Taken: (Document findings on A&O encounter) Yes No Patient Name: Epstein, Jeffrey E Registrar 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 PDF Prescribed by P6400 Replaces BP-A0618 of JUN 10 DOJ-OGR-00026085 --- PAGE BREAK --- BP-A0618 JUN 16 A&O DENTAL EXAMINATION (Initial Clinical Dental Findings) U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS Occlusion: Oral Hygiene: Good Fair Poor CPITN: 3 2 3 3 2 3 Head & Neck / Soft Tissue: D: 0 Classification: CL I M: 14 F: Pain Scale: /10 Dental Prostheses at Intake: Yes No Type: Age: Condition: Comments: advanced need to periodontal recession observed. Lower anterior crowding observed Intra-oral Photos Taken: Yes No 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: Non-urgent: non-urgent Urgent: Referred to Sick Call: Radiographs authorized: PAs: BWs: Panorex: Prophylaxis authorized: Yes No (Approval valid 18 months from examination date) 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 PDF Prescribed by P6400 Replaces BP-A0618 of JUN 10 DOJ-OGR-00026177 --- PAGE BREAK --- Page 2668 BP-A0618 JUN 16 A&O DENTAL EXAMINATION (Initial Clinical Dental Findings) U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS Occlusion: Oral Hygiene: Good Fair Poor CPITN: 3 2 3 3 2 3 Head & Neck / Soft Tissue: D: M: F: /4 Classification: CL I 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: Panorex: Prophylaxis authorized: Yes No (Approval valid 18 months from examination date) Comments: advanced periodontal disease observed. Gingival recession observed. Lower anterior crowding observed Radiographs Taken: (Document findings on A&O encounter) 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 PDF Prescribed by P6400 Replaces BP-A0618 of JUN 10 DOJ-OGR-00026324