Care Plan Evaluation Form sutem [ADV 0, gn woul 1-totk : z Mos 5 Patient Name _ Instructor. GRADING CRITERIA: Asscore of 1 will be given if no significant errors are identified. Ascore of % will be given if 1-3 significant errors are identified. A score of O will be given if required information is missing of deemed inaccurate by the Instructor. LL 1. patent informations present. E 2. Medical History findings are present. LL 3, Medical History risks are identified. 4. socialand Dental history findings are present. 5. Social and Dental history risks are identified. | 6. vental Examiétiohs findings ae présent. Ab. ventat be Ls, Plaque score calculated correctly ition risks are present, | 9, Bleeding score calculated correctly. 10. Periodontal information assessed correctly. A. 1 penta! hyene diagnosis problems stated correctly Lia Dental hygiene diagnosis risk factors or etiology stated. 7 Planned Intervention education stated clearly for each clinical finding {_ 14 Planned intervention ora hygiene is appropriate for each clinical finding. (15. i161 stated clearly (Lite. ste. 3 goals stated appropriate for i761 (__17. 1162 stated clearly. (18. st6 3 goals stated appropriate for LTG 2 (10.16 stated deary. \__ 20 sr6 goats stated appropriate for LTG 3,