1. ALFARABI COLLEAGE
DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGARY
EVALUTION SHEET
Student Name:…………………………….. Patient Name:………………………...
Academic Number:………………….. File Number:…………………………
Level:………….. Group:………… Tooth no: ……………………….. .
PARAMETER STUDENT FULL
MARK MARK
Medical and dental history 2
Diagnosis and treatment plan 2
Armamentarium 2
Infection control 2
Anesthesia land marks 2
Anesthesia performance 4
Extraction 4
Post-operative instructions 2
Total 20
Instructor name: ……………………………
Date: …………………
Signature: …………………….