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Form MHDC
Implant Gigi Palembang
Email
Nama Pasien
Tanggal Pemeriksaan
Nama Dokter
Nomor 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
Lokasi Gigi Hilang
Rahang Atas Kanan
Rahang Atas Kiri
Rahang Bawah Kanan
Rahang Bawah Kiri
Kondisi Tulang Aveolar
Cukup tebal & tinggi
Perlu Bone Graft
Kondisi Gusi
Sehat
Inflamasi
Rekomendasi Dokter
Implant Dentium
Implant Straumann
Jenis Perawatan 1
Administrasi
[GP] Konsultasi Dental
[SP] Konsultasi Dental
[GP] Kontrol Dental
[SP] Kontrol Dental
Kontrol Gigi Palsu (Crown/Inlay/Onlay/Bridge)
Rontgen Dental
Implant Straumann (Include Crown PFM)
Implant Dentium (Include Crown PFM)
[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 Gigi 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 1
Jenis Perawatan 2
Administrasi
[GP] Konsultasi Dental
[SP] Konsultasi Dental
[GP] Kontrol Dental
[SP] Kontrol Dental
Kontrol Gigi Palsu (Crown/Inlay/Onlay/Bridge)
Rontgen Dental
Implant Straumann (Include Crown PFM)
Implant Dentium (Include Crown PFM)
[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 Gigi 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 2
Jenis Perawatan 3
Administrasi
[GP] Konsultasi Dental
[SP] Konsultasi Dental
[GP] Kontrol Dental
[SP] Kontrol Dental
Kontrol Gigi Palsu (Crown/Inlay/Onlay/Bridge)
Rontgen Dental
Implant Straumann (Include Crown PFM)
Implant Dentium (Include Crown PFM)
[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 Gigi 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 3
Jenis Perawatan 4
Administrasi
[GP] Konsultasi Dental
[SP] Konsultasi Dental
[GP] Kontrol Dental
[SP] Kontrol Dental
Kontrol Gigi Palsu (Crown/Inlay/Onlay/Bridge)
Rontgen Dental
Implant Straumann (Include Crown PFM)
Implant Dentium (Include Crown PFM)
[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 Gigi 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 4
Jenis Perawatan Lainnya 1
Administrasi
[GP] Konsultasi Dental
[SP] Konsultasi Dental
[GP] Kontrol Dental
[SP] Kontrol Dental
Kontrol Gigi Palsu (Crown/Inlay/Onlay/Bridge)
Rontgen Dental
Implant Straumann (Include Crown PFM)
Implant Dentium (Include Crown PFM)
[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 Gigi 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 Lainnya 1
Jenis Perawatan Lainnya 2
Administrasi
[GP] Konsultasi Dental
[SP] Konsultasi Dental
[GP] Kontrol Dental
[SP] Kontrol Dental
Kontrol Gigi Palsu (Crown/Inlay/Onlay/Bridge)
Rontgen Dental
Implant Straumann (Include Crown PFM)
Implant Dentium (Include Crown PFM)
[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 Gigi 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 Lainnya 2
Jenis Perawatan Lainnya 3
Administrasi
[GP] Konsultasi Dental
[SP] Konsultasi Dental
[GP] Kontrol Dental
[SP] Kontrol Dental
Kontrol Gigi Palsu (Crown/Inlay/Onlay/Bridge)
Rontgen Dental
Implant Straumann (Include Crown PFM)
Implant Dentium (Include Crown PFM)
[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 Gigi 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 Lainnya 3
Kirim
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