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PERIODONTAL CHART PATIENT NAME Pre-treatment FILE NO. Re-evaluation DATE Recall maintenance Diagnosis CAL BOP PD PI Calc CEJ-GM FACIAL Mobility LINGUAL GM- Gingival Margin. CAL- Clinical Attachment Loss. CEJ- Cementoenamel Junction* PD- Probing Depth Pl- Plaque if presents put. Calc- Calculus if presents put. BOP- Bleeding on probing if presents put red Plaque Index Bleeding Index Periodontal Diagnosis Supervisor s Signature. CEJ- Cementoenamel Junction* PD- Probing Depth Pl- Plaque if presents put. Calc- Calculus if presents put. BOP- Bleeding on probing if presents put red Plaque Index Bleeding Index Periodontal Diagnosis Supervisor s Signature. .

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