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U.S. DOD Form dod-da-3984 DENTAL TREATMENT PLAN For use of this form see TB MED 250 proponent agency is Office of TSG. YES CONSULTATION DESIRED If yes complete Section III on reverse side NO SECTION I - PLANNED TREATMENT AND SEQUENCE OF ACCOMPLISHMENT Check items in Column c to indicate treatment planned. If sequence of treatment is other than that printed in column b use numbers 1 thru 10 in column c to show desired order..

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