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Seattle Study Club Treatment Planning Template. Patient Name. Date of presentation. Treating Clinicians: (Enter name(s) of clinicians here) Age at initial presentation: (Enter age & gender here) Initial presentation date: (Enter date here). Introduction & Background.
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Patient Name Date of presentation
Treating Clinicians: (Enter name(s) of clinicians here)Age at initial presentation: (Enter age & gender here)Initial presentation date: (Enter date here)
Introduction & Background Enter case description here.
Medical History Enter patient information here.
Full Face Smile Full Face Repose • Enter patient data here. Extraoral/Facial Findings
Full Face Profile Smile Full Face Profile Repose • Enter patient findings here. Extraoral Findings, cont.
Smile Close-Up Repose Close-Up • Enter data here. Smile Analysis
Retracted Closed Retracted Open • Enter dental findings here. Dental Findings
Left Lateral Right Lateral • Enter occlusal findings here. Occlusal Notes
Maxillary Occlusal Mandibular Occlusal • Enter occlusal findings here. Occlusal Notes
Additional Image Additional Image • Enter any additional findings or concerns here. Additional Notes
TMJ & Mandibular Range of Motion Enter TMJ findings here.
Periodontal Findings Enter periodontal findings here.
Insert Date Here Panorex or FMX • Enter radiographic findings here. Radiographic Findings
Diagnosis & Prognosis Diagnosis Type in here. Prognosis Periodontal: Biomechanical/Structural: Functional: Esthetic:
Summary of Concerns Enter summary of concerns here.
Proposed Treatment Plan Enter proposed treatment plan here.
Proposed Treatment Plan, cont. Continue proposed treatment plan.
Review of Treatment Goals Enter the goals here.
Active Treatment - Phase I Enter Phase I treatment here.
Phase II Enter Phase II treatment here.
Phase III Enter Phase III treatment here.
Phase IV Enter Phase IV treatment here.
Phase V Enter Phase V treatment here.
Phase VI Enter Phase VI treatment here.
Phase VII Enter Phase VII treatment here.
Enter commentary here. Commentary
Enter post-treatment information and/or commentary here. Post-Treatment Follow-up