ALFARABI COLLEAGE

DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGARY

EVALUTION SHEET

Student Name:…………………………….. Patient Name:………………………...

Academic Number:………………….. File Number:…………………………

Level:………….. Group:………… Tooth no: ……………………….. .

FULL

MARK

STUDENT

MARK PARAMETER

2 Medical and dental history

2 Diagnosis and treatment plan

2 Armamentarium

2 Infection control

2 Anesthesia land marks

4 Anesthesia performance

4 Extraction

2 Post-operative instructions

20 Total

Instructor name: ……………………………

Date: …………………

Signature: …………………….