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Hospital CMS

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PATIENT NAME	GENDER	PATIENT NUMBER	DOB	AGE(YRS)	MONTHS	DAYS
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Patient Triage Results

Patient Number

Temperature

SPO2

PR

Weight

BP

Height

RR

Alergy

HA

CP

ABD

SKIN

Chief Complain

Triage Done By:

Patient Diagnosis

Diagnosis

Dental Requests corporate

Ksh 1000

ADDITIONAL TOOTH

Ksh 4000

Ankel Joint

Ksh 5000

CLOSSED IMPACTION

Ksh 30000

COMPLETE DENTURE

Ksh 10000

CROWNS - ACYLIC

Ksh 15000

CROWNS -PFM

Ksh 15000

CROWNS -VEENERS

Ksh 500

CXR-Chest X-Ray

Ksh 500

DRY SOCKET

Ksh 1500

ECG TEST

Ksh 6500

Echo

Ksh 1500

EXTRACTION

Ksh 3000

FISSURE SEALANT

Ksh 400

Foot

Ksh 400

Heel/Calcaneus

Ksh 2000

IMPRESSION

Ksh 25000

ORTHO - REMOVAL

Ksh 100000

ORTHO -FIXED

Ksh 50000

ORTHO- LOWER JAW/UPPER

Ksh 2500

PARTIAL DENTURE

Ksh 4500

PARTIAL FILLING

Ksh 600

Pelvis/Hip X-Ray

Ksh 2000

PROPHY

Ksh 10000

ROOT CANAL TREATMENT

Ksh 1000

ROOT CANAL TREATMENT POSTERIOOR

Ksh 4500

SCALLING

Ksh 3000

SCALLING -FULL MOUTH

Ksh 2000

SCALLING HALF

Ksh 600

Spine

Ksh 5000

SPLINTING (2)

Ksh 2000

STUDY MODEL

Ksh 600

SXR-Skull X-ray

Ksh 1000

TEMPORARY FILLING

Ksh 2000

TOPICAL FLUORIDE

Ksh 30000

WHITENING(1)

Ksh 20000

WHITENING(2)

Ksh 20000

ZYCONIUM

Dental Requests

Ksh 200

CONSULTATION FEE

Ksh 6000

CROWNS - ACYLIC

Ksh 10000

CROWNS -PFM

Ksh 8000

CROWNS -VEENERS

Ksh 500

CXR-Chest X-Ray

Ksh 300

DRY SOCKET

Ksh 1500

ECG TEST

Ksh 1000

EXTRACTION

Ksh 2000

FISSURE SEALANT

Ksh 3000

FULL MOUTH WASH

Ksh 400

Heel/Calcaneus

Ksh 2000

IMPACTION

Ksh 25000

ORTHO - REMOVAL

Ksh 100000

ORTHO -FIXED

Ksh 50000

ORTHO- LOWER JAW/UPPER

Ksh 2500

PARTIAL DENTURE

Ksh 3000

PARTIAL FILLING

Ksh 600

Pelvis/Hip X-Ray

Ksh 4000

ROOT CANAL TREATMENT

Ksh 6000

ROOT CANAL TREATMENT POSTERIOOR

Ksh 2000

SCALLING -FULL MOUTH MILD

Ksh 400

SCALLING HALF

Ksh 2000

SCALLING HALF MILD

Ksh 400

SCALLING PER TOOTH

Ksh 4500

SCALLING SEVERE

Ksh 600

Spine

Ksh 3000

SPLINTING

Ksh 1500

STUDY MODEL

Ksh 600

SXR-Skull X-ray

Ksh 500

TEMPORARY FILLING

Ksh 1500

TOPICAL FLUORIDE

Ksh 400

TROPICAL FLUORIDE

Ksh 30000

WHITENING(1) INSTANT BOOST 40%

Ksh 20000

WHITENING(2) MASKING

Ksh 12000

ZYCONIUM

Transfer Patient

Send to general

Radiology Requests

Ksh 1500

abdominal

Ksh 2000

Abdominal pelvic

Ksh 400

Ankel Joint

Ksh 600

AXR-Abdominal X-Ray

Ksh 1000

Barium / meal

Ksh 1500

Barium Enema

Ksh 1000

Barium follow through

Ksh 800

barium swallow

Ksh 500

CXR-Chest X-Ray

Ksh 1700

Doppler

Ksh 1500

ECG TEST

Ksh 6500

Echo

Ksh 400

Elbow

Ksh 400

Femur

Ksh 400

Fingers

Ksh 400

Foot

Ksh 400

Forearm

Ksh 400

Hand

Ksh 400

Heel/Calcaneus

Ksh 2000

HSG

Ksh 400

Humerous

Ksh 400

Knee

Ksh 2000

MCU

Ksh 1400

Obstetric u/s

Ksh 1500

pelvic u/s

Ksh 600

Pelvis/Hip X-Ray

Ksh 400

Shoulder

Ksh 1500

Small parts

Ksh 600

Spine

Ksh 600

SXR-Skull X-ray

Ksh 1700

testicular

Ksh 400

Thumb

Ksh 1500

Thyroid

Ksh 400

Tib/Fib

Ksh 1700

Transviginal

Ksh 400

Wrist

Comments

Comments

Prescription

Comments

Appointment

Appointment Date

Chropractic

Diabetic

General

Gynacology

Hypertension

Obsterics

Pediatric

Surgical

Triage Results

Dental

Dental Corporate

Diagnosis

Comment

Prescribe

Appointment

Transfer

Notes

Notes

Brief History

On physical examination

Family social & economic history
Adittional notes
Investigation Done

Systematic review

ROS

Fever

Weak

Night Sweat

SKIN

Rash

Burn

Jaundice

Lesion

EYE

Vision

Pain

d/c

Blind

ENMT

Ear pain

SR throat

Sinus

Neck Mass

RESP

Sob

Cough

Wheeze

CV

Cp

Tachy

Syncope

Edema

GI

Abd Pain

n/v

Diarrhea

Rectal Pain

GU

Dysuria

Hematuria

Vag bleed

Vaginal d/c

MS

Back pain

Muscle

Joint

NEURO

h/a

Dizzy

Ams

Numb

PSYCH

Anxiety

Dipressed

Substance abuse

ENDOCRINE

Polyuria

Hyperglycemia

Hot/cold intol

HEME/LYM

Bruising/bleeding

Swelling

Diagnosis/Examination

CV

CAD

HTN

MI

CHF

DVT

Afib

RESP

Asthma

Pneumonia

TB

COPD

ENDO

DM

Thyroid dz

GI

GERD

IBS

Hepatitis

Colitis

GU

UTI

STD

DUB

NEURO

CVA

H/A

SZ

PSYCH

Depressed

ETOH abuse

Bipolar

ms

Back

Joint

Muscle

Medical History

ALERGIES

Alergies

Meds

LMP

PMH/Cancer