Clinical Laboratory Form
| STUDENT NAME | |
|---|---|
| Student Clinician Code | |
| Patient Name | |
| Patient Temp | |
| Type of case |
Every stage must be signed before progressing to next stage
Clinical and Laboratory Progress Tracking
Final Impressions and Master Casts1
| STAGE | DATE, SIGNATURE AND CLINICIAN CODE | COMMENTS/NOTES |
|---|---|---|
| Study Models/Working Models | ||
| Model Mounting | ||
| Convenience Tray | ||
| Approved Form 26 | ||
| Mouth Preparation | ||
| Final Impressions | ||
| Master Cast Lab | ||
| Base and Rim Lab | ||
| Relations | ||
| Mounting Lab | ||
| laboratory slip- Shade, return date, detailed instructions, suitable material choice | ||
| Case Logged in Laboratory Software Lab | ||
| Framework Fabrication Lab | ||
| Restoration Approved Lab | ||
| Try In | ||
| Anterior Tooth Set Lab |
 |  |
 |
Laboratory Processing and Completion2
Posterior Tooth Set {Lab}
Process {Lab}
This form must be completed and submitted with Laboratory Lab Slip.
Footnotes
-
Original PDF page 1: Removable Prosthodontics and Laboratory Stages (Progress Monitor), p.1 ↩
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Original PDF page 2: Removable Prosthodontics and Laboratory Stages (Progress Monitor), p.2 ↩