CLINICAL HISTORY Page 1 of 3
Patient FETIYA AHMED WARIYO D.O.B 13/04/90 MR.No 21586 Date 17/10/2021
Address ABU DHABI Age Consult
31 Years 6 Months 4 Days ID 69934 Company HAAD
Nationality Ethiopian Sex F Time In 17:30:00 Plan 01
Doctor MOHAMED MATAR Phone 0504893462 Time Out 18:00:00 Group 01
License GD22427 Mobile 0504893462 V.Status New Card No
Chief Complaints
Patient complains of deviation
X of face 2 days back and also pain in lower left back
tooth region
HPI - History Of Present Illness
When did the problem start ? 2 days back
What did you notice first ? facial discomfort, weakness of face , and also pain in lower left back tooth region
yes related to this ?
Did you have any problem or symptom
What make the problem Wrose ?eating
What have you done to treat thisNothing
problems ?
No to daignosis ?
Have any tests been performed before
No for this problem
Have you consulted any other doctors
What type of pain you have? pain on lower left back tooth region,,
What time pain increase more? Sharp pain
No
Have you had any Ortho Treatment?
When did you clean the teeth lastToday
time? , poor oral hygiene
PMH - Past Medical History
Hypertensive ? NO
Married ? NO
Pregnant ? NOT APPLICABLE
Breast Feeding ? NO
Diabetic ? NO
Family Hx
No Cancer :
No
Hypertension :
No
Diabetes :
No Failure :
Renal
GeneticNo
Disorders :
Social Hx
Do you smoke ? No
Do you drink Alcohols ? No
Do you hace pets at home ? No
Languages spoken ? No
Others: No
Personal History
Oral Habits None
Oral Hygiene Oractice bad
>>Regularity of brushing not regular
>>Frequency and methods ofonce
brushing
>>Smoking NA
>>Tabacco Chewing NA
>>Alcohol NA
Vital Signs
>> Temp Pulse Respiratory Systolic Diastolic
Patient FETIYA AHMED WARIYO D.O.B 13/04/90 MR.No 21586 Date 17/10/2021
Address ABU DHABI Age Consult
31 Years 6 Months 4 Days ID 69934 Company HAAD
Nationality Ethiopian Sex F Time In 17:30:00 Plan 01
Doctor MOHAMED MATAR Phone 0504893462 Time Out 18:00:00 Group 01
License GD22427 Mobile 0504893462 V.Status New Card No
Chief Complaints
Patient complains of deviation
X of face 2 days back and also pain in lower left back
tooth region
HPI - History Of Present Illness
When did the problem start ? 2 days back
What did you notice first ? facial discomfort, weakness of face , and also pain in lower left back tooth region
yes related to this ?
Did you have any problem or symptom
What make the problem Wrose ?eating
What have you done to treat thisNothing
problems ?
No to daignosis ?
Have any tests been performed before
No for this problem
Have you consulted any other doctors
What type of pain you have? pain on lower left back tooth region,,
What time pain increase more? Sharp pain
No
Have you had any Ortho Treatment?
When did you clean the teeth lastToday
time? , poor oral hygiene
PMH - Past Medical History
Hypertensive ? NO
Married ? NO
Pregnant ? NOT APPLICABLE
Breast Feeding ? NO
Diabetic ? NO
Family Hx
No Cancer :
No
Hypertension :
No
Diabetes :
No Failure :
Renal
GeneticNo
Disorders :
Social Hx
Do you smoke ? No
Do you drink Alcohols ? No
Do you hace pets at home ? No
Languages spoken ? No
Others: No
Personal History
Oral Habits None
Oral Hygiene Oractice bad
>>Regularity of brushing not regular
>>Frequency and methods ofonce
brushing
>>Smoking NA
>>Tabacco Chewing NA
>>Alcohol NA
Vital Signs
>> Temp Pulse Respiratory Systolic Diastolic
