10.
Recording Dental Examination, Diagnosis and Treatment, and Appointment
Control is the title of:
a. TB MED 148.
b. AR 40-66.
c.
TB MED 250.
d. AR 40-16.
11.
Dental Statistical Reporting is the title of:
a. TB MED 148.
b. AR 40-66.
c.
TB MED 250.
d. AR 40-16.
12.
Match the title of the form in Column I to the form number in Column II.
COLUMN I
COLUMN II
(1) ____ Dental Health Record Folder.
a. DA Form 3984
(2) ____ Health Record--Dental.
b. SF 522.
(3) ____ Dental Laboratory Work Authorization.
c.
DA Form 5570.
(4) ____ Dental Treatment Plan.
d. DD Form 3444.
e. SF 603.
(5) ____ Request for Administration of
Anesthesia and for Performance of
Operations and Other Procedures.
(6) ____ Health Questionnaire for Dental Treatment
f.
DD Form 2322.
MD0510
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