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Form MHDC
Gigi Palsu Palembang
Email
Nama Pasien
Tanggal Pemeriksaan
Nama Dokter
No Rekam Medis
Nomor WhatsApp
Cabang
Medikids Bekasi
Medikids Bintaro
Medikids BSD
Medikids Cibinong
Medikids Cibubur
Medikids Cipondoh
Medikids Dago
Medikids Grand Wisata
Medikids Green Terrace
Medikids Kebon Jeruk
Medikids Kemang
Medikids Lebak Bulus
Medikids Makassar
Medikids Palembang
Medikids Pondok Indah
Medikids Semarang
Medikids Wakaf Bogor
Medikids Wakaf Cikupa
Medikids Wakaf Cilegon
Medikids Wakaf Depok
Medikids Wakaf JGC
Medikids Wakaf Kalimalang
Medikids Wakaf Karawang
Medikids Wakaf Padang
Medikids Wakaf Sawangan
Medikids Wakaf Surabaya
MHDC Bulog
MHDC Kalibata City
MHDC Sentraya
MHDC Wisma 46
Foto Intraoral/Rontgen
Gigi Hilang
Sebagian
Total
Gigi Tersisa
Stabil
Perlu dicabut
Gusi
Sehat
Luka
Hipermobil
Rahang
Stabil
Cekung/Mengecil
Gigitan
Normal
Perlu Penyesuaian
Rekomendasi Dokter
GTL Akrilik
GTL Valplast
GTL Thermosen
GTL Kerangka Logam
GTSKL Kombinasi Thermosen
GTSKL Kombinasi Valplast
GTSKL Kombinasi Akrilik
Jenis Perawatan 1
Administrasi
[GP] Konsultasi Dental
[SP] Konsultasi Dental
[GP] Kontrol Dental
[SP] Kontrol Dental
Rontgen Dental
[GP] GTSL Akrilik (Plat + Gigi Pertama)
[SP] GTSL Akrilik (Plat + Gigi Pertama)
[GP] GTSL Valplast (Plat + Gigi Pertama)
[SP] GTSL Valplast (Plat + Gigi Pertama)
[GP] GTSL Thermosen
[SP] GTSL Thermosen
GTL Kerangka Logam (Frame + Gigi Pertama)
GTSKL Kombinasi Thermosen
GTSKL Kombinasi Valplast
GTSKL Kombinasi Akrilik
[GP] Cabut Gigi Tipe 1
[GP] Cabut Gigi Tipe 2
[GP] Cabut Gigi Tipe 3
[SP] Cabut Gigi Tipe 1
[SP] Cabut Gigi Tipe 2
[SP] Cabut Gigi Tipe 3
[GP] Cabut Gigi Komplikasi Tipe 1
[GP] Cabut Gigi Komplikasi Tipe 2
[GP] Cabut Gigi Komplikasi Tipe 3
[SP] Cabut Gigi Komplikasi Tipe 1
[SP] Cabut Gigi Komplikasi Tipe 2
[SP] Cabut Gigi Komplikasi Tipe 3
[GP] Cabut Gigi Impaksi Tipe 1
[SP] Cabut Gigi Impaksi Tipe 1
Cabut Gigi Impaksi Tipe 2
Cabut Gigi Impaksi Tipe 3
[GP] Crown/Inlay/Onlay/Bridge Metal
[SP] Crown/Inlay/Onlay/Bridge Metal
[GP] Crown/Inlay/Onlay/Bridge Metal Porcelain
[SP] Crown/Inlay/Onlay/Bridge Metal Porcelain
Crown/Inlay/Onlay/Bridge Composite Resin Reinforced Zirconia
[GP] Crown/Inlay/Onlay/Bridge Ceramic E-Max
[SP] Crown/Inlay/Onlay/Bridge Ceramic E-Max
[GP] Crown/Inlay/Onlay/Bridge Ceramic Zircon
[SP] Crown/Inlay/Onlay/Bridge Ceramic Zircon
Cetak Alginate
Cetak Alginate RARB
Cetak Rubber Base
Cetak RARB Rubber Base
[GP] Tambahan Gigi (Gigi Lepasan)
[SP] Tambahan Gigi (Gigi Lepasan)
Sementasi GIC
Sementasi Resin
Temporary Crown Direct
Temporary Crown Indirect
Jumlah Gigi/Tindakan
Jenis Perawatan 2
Administrasi
[GP] Konsultasi Dental
[SP] Konsultasi Dental
[GP] Kontrol Dental
[SP] Kontrol Dental
Rontgen Dental
[GP] GTSL Akrilik (Plat + Gigi Pertama)
[SP] GTSL Akrilik (Plat + Gigi Pertama)
[GP] GTSL Valplast (Plat + Gigi Pertama)
[SP] GTSL Valplast (Plat + Gigi Pertama)
[GP] GTSL Thermosen
[SP] GTSL Thermosen
GTL Kerangka Logam (Frame + Gigi Pertama)
GTSKL Kombinasi Thermosen
GTSKL Kombinasi Valplast
GTSKL Kombinasi Akrilik
[GP] Cabut Gigi Tipe 1
[GP] Cabut Gigi Tipe 2
[GP] Cabut Gigi Tipe 3
[SP] Cabut Gigi Tipe 1
[SP] Cabut Gigi Tipe 2
[SP] Cabut Gigi Tipe 3
[GP] Cabut Gigi Komplikasi Tipe 1
[GP] Cabut Gigi Komplikasi Tipe 2
[GP] Cabut Gigi Komplikasi Tipe 3
[SP] Cabut Gigi Komplikasi Tipe 1
[SP] Cabut Gigi Komplikasi Tipe 2
[SP] Cabut Gigi Komplikasi Tipe 3
[GP] Cabut Gigi Impaksi Tipe 1
[SP] Cabut Gigi Impaksi Tipe 1
Cabut Gigi Impaksi Tipe 2
Cabut Gigi Impaksi Tipe 3
[GP] Crown/Inlay/Onlay/Bridge Metal
[SP] Crown/Inlay/Onlay/Bridge Metal
[GP] Crown/Inlay/Onlay/Bridge Metal Porcelain
[SP] Crown/Inlay/Onlay/Bridge Metal Porcelain
Crown/Inlay/Onlay/Bridge Composite Resin Reinforced Zirconia
[GP] Crown/Inlay/Onlay/Bridge Ceramic E-Max
[SP] Crown/Inlay/Onlay/Bridge Ceramic E-Max
[GP] Crown/Inlay/Onlay/Bridge Ceramic Zircon
[SP] Crown/Inlay/Onlay/Bridge Ceramic Zircon
Cetak Alginate
Cetak Alginate RARB
Cetak Rubber Base
Cetak RARB Rubber Base
[GP] Tambahan Gigi (Gigi Lepasan)
[SP] Tambahan Gigi (Gigi Lepasan)
Sementasi GIC
Sementasi Resin
Temporary Crown Direct
Temporary Crown Indirect
Jumlah Gigi/Tindakan
Jenis Perawatan 3
Administrasi
[GP] Konsultasi Dental
[SP] Konsultasi Dental
[GP] Kontrol Dental
[SP] Kontrol Dental
Rontgen Dental
[GP] GTSL Akrilik (Plat + Gigi Pertama)
[SP] GTSL Akrilik (Plat + Gigi Pertama)
[GP] GTSL Valplast (Plat + Gigi Pertama)
[SP] GTSL Valplast (Plat + Gigi Pertama)
[GP] GTSL Thermosen
[SP] GTSL Thermosen
GTL Kerangka Logam (Frame + Gigi Pertama)
GTSKL Kombinasi Thermosen
GTSKL Kombinasi Valplast
GTSKL Kombinasi Akrilik
[GP] Cabut Gigi Tipe 1
[GP] Cabut Gigi Tipe 2
[GP] Cabut Gigi Tipe 3
[SP] Cabut Gigi Tipe 1
[SP] Cabut Gigi Tipe 2
[SP] Cabut Gigi Tipe 3
[GP] Cabut Gigi Komplikasi Tipe 1
[GP] Cabut Gigi Komplikasi Tipe 2
[GP] Cabut Gigi Komplikasi Tipe 3
[SP] Cabut Gigi Komplikasi Tipe 1
[SP] Cabut Gigi Komplikasi Tipe 2
[SP] Cabut Gigi Komplikasi Tipe 3
[GP] Cabut Gigi Impaksi Tipe 1
[SP] Cabut Gigi Impaksi Tipe 1
Cabut Gigi Impaksi Tipe 2
Cabut Gigi Impaksi Tipe 3
[GP] Crown/Inlay/Onlay/Bridge Metal
[SP] Crown/Inlay/Onlay/Bridge Metal
[GP] Crown/Inlay/Onlay/Bridge Metal Porcelain
[SP] Crown/Inlay/Onlay/Bridge Metal Porcelain
Crown/Inlay/Onlay/Bridge Composite Resin Reinforced Zirconia
[GP] Crown/Inlay/Onlay/Bridge Ceramic E-Max
[SP] Crown/Inlay/Onlay/Bridge Ceramic E-Max
[GP] Crown/Inlay/Onlay/Bridge Ceramic Zircon
[SP] Crown/Inlay/Onlay/Bridge Ceramic Zircon
Cetak Alginate
Cetak Alginate RARB
Cetak Rubber Base
Cetak RARB Rubber Base
[GP] Tambahan Gigi (Gigi Lepasan)
[SP] Tambahan Gigi (Gigi Lepasan)
Sementasi GIC
Sementasi Resin
Temporary Crown Direct
Temporary Crown Indirect
Jumlah Gigi/Tindakan
Jenis Perawatan 4
Administrasi
[GP] Konsultasi Dental
[SP] Konsultasi Dental
[GP] Kontrol Dental
[SP] Kontrol Dental
Rontgen Dental
[GP] GTSL Akrilik (Plat + Gigi Pertama)
[SP] GTSL Akrilik (Plat + Gigi Pertama)
[GP] GTSL Valplast (Plat + Gigi Pertama)
[SP] GTSL Valplast (Plat + Gigi Pertama)
[GP] GTSL Thermosen
[SP] GTSL Thermosen
GTL Kerangka Logam (Frame + Gigi Pertama)
GTSKL Kombinasi Thermosen
GTSKL Kombinasi Valplast
GTSKL Kombinasi Akrilik
[GP] Cabut Gigi Tipe 1
[GP] Cabut Gigi Tipe 2
[GP] Cabut Gigi Tipe 3
[SP] Cabut Gigi Tipe 1
[SP] Cabut Gigi Tipe 2
[SP] Cabut Gigi Tipe 3
[GP] Cabut Gigi Komplikasi Tipe 1
[GP] Cabut Gigi Komplikasi Tipe 2
[GP] Cabut Gigi Komplikasi Tipe 3
[SP] Cabut Gigi Komplikasi Tipe 1
[SP] Cabut Gigi Komplikasi Tipe 2
[SP] Cabut Gigi Komplikasi Tipe 3
[GP] Cabut Gigi Impaksi Tipe 1
[SP] Cabut Gigi Impaksi Tipe 1
Cabut Gigi Impaksi Tipe 2
Cabut Gigi Impaksi Tipe 3
[GP] Crown/Inlay/Onlay/Bridge Metal
[SP] Crown/Inlay/Onlay/Bridge Metal
[GP] Crown/Inlay/Onlay/Bridge Metal Porcelain
[SP] Crown/Inlay/Onlay/Bridge Metal Porcelain
Crown/Inlay/Onlay/Bridge Composite Resin Reinforced Zirconia
[GP] Crown/Inlay/Onlay/Bridge Ceramic E-Max
[SP] Crown/Inlay/Onlay/Bridge Ceramic E-Max
[GP] Crown/Inlay/Onlay/Bridge Ceramic Zircon
[SP] Crown/Inlay/Onlay/Bridge Ceramic Zircon
Cetak Alginate
Cetak Alginate RARB
Cetak Rubber Base
Cetak RARB Rubber Base
[GP] Tambahan Gigi (Gigi Lepasan)
[SP] Tambahan Gigi (Gigi Lepasan)
Sementasi GIC
Sementasi Resin
Temporary Crown Direct
Temporary Crown Indirect
Jumlah Gigi/Tindakan
Jenis Perawatan 5
Administrasi
[GP] Konsultasi Dental
[SP] Konsultasi Dental
[GP] Kontrol Dental
[SP] Kontrol Dental
Rontgen Dental
[GP] GTSL Akrilik (Plat + Gigi Pertama)
[SP] GTSL Akrilik (Plat + Gigi Pertama)
[GP] GTSL Valplast (Plat + Gigi Pertama)
[SP] GTSL Valplast (Plat + Gigi Pertama)
[GP] GTSL Thermosen
[SP] GTSL Thermosen
GTL Kerangka Logam (Frame + Gigi Pertama)
GTSKL Kombinasi Thermosen
GTSKL Kombinasi Valplast
GTSKL Kombinasi Akrilik
[GP] Cabut Gigi Tipe 1
[GP] Cabut Gigi Tipe 2
[GP] Cabut Gigi Tipe 3
[SP] Cabut Gigi Tipe 1
[SP] Cabut Gigi Tipe 2
[SP] Cabut Gigi Tipe 3
[GP] Cabut Gigi Komplikasi Tipe 1
[GP] Cabut Gigi Komplikasi Tipe 2
[GP] Cabut Gigi Komplikasi Tipe 3
[SP] Cabut Gigi Komplikasi Tipe 1
[SP] Cabut Gigi Komplikasi Tipe 2
[SP] Cabut Gigi Komplikasi Tipe 3
[GP] Cabut Gigi Impaksi Tipe 1
[SP] Cabut Gigi Impaksi Tipe 1
Cabut Gigi Impaksi Tipe 2
Cabut Gigi Impaksi Tipe 3
[GP] Crown/Inlay/Onlay/Bridge Metal
[SP] Crown/Inlay/Onlay/Bridge Metal
[GP] Crown/Inlay/Onlay/Bridge Metal Porcelain
[SP] Crown/Inlay/Onlay/Bridge Metal Porcelain
Crown/Inlay/Onlay/Bridge Composite Resin Reinforced Zirconia
[GP] Crown/Inlay/Onlay/Bridge Ceramic E-Max
[SP] Crown/Inlay/Onlay/Bridge Ceramic E-Max
[GP] Crown/Inlay/Onlay/Bridge Ceramic Zircon
[SP] Crown/Inlay/Onlay/Bridge Ceramic Zircon
Cetak Alginate
Cetak Alginate RARB
Cetak Rubber Base
Cetak RARB Rubber Base
[GP] Tambahan Gigi (Gigi Lepasan)
[SP] Tambahan Gigi (Gigi Lepasan)
Sementasi GIC
Sementasi Resin
Temporary Crown Direct
Temporary Crown Indirect
Jumlah Gigi/Tindakan
Jenis Perawatan Lainnya 1
Administrasi
[GP] Konsultasi Dental
[SP] Konsultasi Dental
[GP] Kontrol Dental
[SP] Kontrol Dental
Rontgen Dental
[GP] GTSL Akrilik (Plat + Gigi Pertama)
[SP] GTSL Akrilik (Plat + Gigi Pertama)
[GP] GTSL Valplast (Plat + Gigi Pertama)
[SP] GTSL Valplast (Plat + Gigi Pertama)
[GP] GTSL Thermosen
[SP] GTSL Thermosen
GTL Kerangka Logam (Frame + Gigi Pertama)
GTSKL Kombinasi Thermosen
GTSKL Kombinasi Valplast
GTSKL Kombinasi Akrilik
[GP] Cabut Gigi Tipe 1
[GP] Cabut Gigi Tipe 2
[GP] Cabut Gigi Tipe 3
[SP] Cabut Gigi Tipe 1
[SP] Cabut Gigi Tipe 2
[SP] Cabut Gigi Tipe 3
[GP] Cabut Gigi Komplikasi Tipe 1
[GP] Cabut Gigi Komplikasi Tipe 2
[GP] Cabut Gigi Komplikasi Tipe 3
[SP] Cabut Gigi Komplikasi Tipe 1
[SP] Cabut Gigi Komplikasi Tipe 2
[SP] Cabut Gigi Komplikasi Tipe 3
[GP] Cabut Gigi Impaksi Tipe 1
[SP] Cabut Gigi Impaksi Tipe 1
Cabut Gigi Impaksi Tipe 2
Cabut Gigi Impaksi Tipe 3
[GP] Crown/Inlay/Onlay/Bridge Metal
[SP] Crown/Inlay/Onlay/Bridge Metal
[GP] Crown/Inlay/Onlay/Bridge Metal Porcelain
[SP] Crown/Inlay/Onlay/Bridge Metal Porcelain
Crown/Inlay/Onlay/Bridge Composite Resin Reinforced Zirconia
[GP] Crown/Inlay/Onlay/Bridge Ceramic E-Max
[SP] Crown/Inlay/Onlay/Bridge Ceramic E-Max
[GP] Crown/Inlay/Onlay/Bridge Ceramic Zircon
[SP] Crown/Inlay/Onlay/Bridge Ceramic Zircon
Cetak Alginate
Cetak Alginate RARB
Cetak Rubber Base
Cetak RARB Rubber Base
[GP] Tambahan Gigi (Gigi Lepasan)
[SP] Tambahan Gigi (Gigi Lepasan)
Sementasi GIC
Sementasi Resin
Temporary Crown Direct
Temporary Crown Indirect
Jumlah Gigi/Tindakan
Jenis Perawatan Lainnya 2
Administrasi
[GP] Konsultasi Dental
[SP] Konsultasi Dental
[GP] Kontrol Dental
[SP] Kontrol Dental
Rontgen Dental
[GP] GTSL Akrilik (Plat + Gigi Pertama)
[SP] GTSL Akrilik (Plat + Gigi Pertama)
[GP] GTSL Valplast (Plat + Gigi Pertama)
[SP] GTSL Valplast (Plat + Gigi Pertama)
[GP] GTSL Thermosen
[SP] GTSL Thermosen
GTL Kerangka Logam (Frame + Gigi Pertama)
GTSKL Kombinasi Thermosen
GTSKL Kombinasi Valplast
GTSKL Kombinasi Akrilik
[GP] Cabut Gigi Tipe 1
[GP] Cabut Gigi Tipe 2
[GP] Cabut Gigi Tipe 3
[SP] Cabut Gigi Tipe 1
[SP] Cabut Gigi Tipe 2
[SP] Cabut Gigi Tipe 3
[GP] Cabut Gigi Komplikasi Tipe 1
[GP] Cabut Gigi Komplikasi Tipe 2
[GP] Cabut Gigi Komplikasi Tipe 3
[SP] Cabut Gigi Komplikasi Tipe 1
[SP] Cabut Gigi Komplikasi Tipe 2
[SP] Cabut Gigi Komplikasi Tipe 3
[GP] Cabut Gigi Impaksi Tipe 1
[SP] Cabut Gigi Impaksi Tipe 1
Cabut Gigi Impaksi Tipe 2
Cabut Gigi Impaksi Tipe 3
[GP] Crown/Inlay/Onlay/Bridge Metal
[SP] Crown/Inlay/Onlay/Bridge Metal
[GP] Crown/Inlay/Onlay/Bridge Metal Porcelain
[SP] Crown/Inlay/Onlay/Bridge Metal Porcelain
Crown/Inlay/Onlay/Bridge Composite Resin Reinforced Zirconia
[GP] Crown/Inlay/Onlay/Bridge Ceramic E-Max
[SP] Crown/Inlay/Onlay/Bridge Ceramic E-Max
[GP] Crown/Inlay/Onlay/Bridge Ceramic Zircon
[SP] Crown/Inlay/Onlay/Bridge Ceramic Zircon
Cetak Alginate
Cetak Alginate RARB
Cetak Rubber Base
Cetak RARB Rubber Base
[GP] Tambahan Gigi (Gigi Lepasan)
[SP] Tambahan Gigi (Gigi Lepasan)
Sementasi GIC
Sementasi Resin
Temporary Crown Direct
Temporary Crown Indirect
Jumlah Gigi/Tindakan
Jenis Perawatan Lainnya 3
Administrasi
[GP] Konsultasi Dental
[SP] Konsultasi Dental
[GP] Kontrol Dental
[SP] Kontrol Dental
Rontgen Dental
[GP] GTSL Akrilik (Plat + Gigi Pertama)
[SP] GTSL Akrilik (Plat + Gigi Pertama)
[GP] GTSL Valplast (Plat + Gigi Pertama)
[SP] GTSL Valplast (Plat + Gigi Pertama)
[GP] GTSL Thermosen
[SP] GTSL Thermosen
GTL Kerangka Logam (Frame + Gigi Pertama)
GTSKL Kombinasi Thermosen
GTSKL Kombinasi Valplast
GTSKL Kombinasi Akrilik
[GP] Cabut Gigi Tipe 1
[GP] Cabut Gigi Tipe 2
[GP] Cabut Gigi Tipe 3
[SP] Cabut Gigi Tipe 1
[SP] Cabut Gigi Tipe 2
[SP] Cabut Gigi Tipe 3
[GP] Cabut Gigi Komplikasi Tipe 1
[GP] Cabut Gigi Komplikasi Tipe 2
[GP] Cabut Gigi Komplikasi Tipe 3
[SP] Cabut Gigi Komplikasi Tipe 1
[SP] Cabut Gigi Komplikasi Tipe 2
[SP] Cabut Gigi Komplikasi Tipe 3
[GP] Cabut Gigi Impaksi Tipe 1
[SP] Cabut Gigi Impaksi Tipe 1
Cabut Gigi Impaksi Tipe 2
Cabut Gigi Impaksi Tipe 3
[GP] Crown/Inlay/Onlay/Bridge Metal
[SP] Crown/Inlay/Onlay/Bridge Metal
[GP] Crown/Inlay/Onlay/Bridge Metal Porcelain
[SP] Crown/Inlay/Onlay/Bridge Metal Porcelain
Crown/Inlay/Onlay/Bridge Composite Resin Reinforced Zirconia
[GP] Crown/Inlay/Onlay/Bridge Ceramic E-Max
[SP] Crown/Inlay/Onlay/Bridge Ceramic E-Max
[GP] Crown/Inlay/Onlay/Bridge Ceramic Zircon
[SP] Crown/Inlay/Onlay/Bridge Ceramic Zircon
Cetak Alginate
Cetak Alginate RARB
Cetak Rubber Base
Cetak RARB Rubber Base
[GP] Tambahan Gigi (Gigi Lepasan)
[SP] Tambahan Gigi (Gigi Lepasan)
Sementasi GIC
Sementasi Resin
Temporary Crown Direct
Temporary Crown Indirect
Jumlah Gigi/Tindakan
Kirim
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