Стоматолог

Прикус: ___________________________________________________________________

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Слизистая полости рта: ____________________________________________________

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Зубы:

18

17

16

15

14

13

12

11

21

22

23

24

25

26

27

28

48

47

46

45

44

43

42

41

31

32

33

34

35

36

37

38

Десны: ____________________________________________________________________

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Диагноз: __________________________________________________________________

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Заключение: _______________________________________________________________

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"__" ________________ 20__ г. _____________ ___________________

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