1. Seattle Study Club Treatment Planning Template

2. Patient Name Date of presentation

3. Treating Clinicians: (Enter name(s) of clinicians here) Age at initial presentation: (Enter age & gender here) Initial presentation date: (Enter date here)

4. Introduction & Background  Enter case description here.

5. Medical History  Enter patient information here.

6. Diagnostic Findings

7. Full Face Smile Full Face Repose Extraoral/Facial Findings  Enter patient data here.

8. Full Face Profile Smile Full Face Profile Repose Extraoral Findings, cont.  Enter patient findings here.

9. Smile Close-Up Repose Close-Up Smile Analysis  Enter data here.

10. Retracted Closed Retracted Open Dental Findings  Enter dental findings here.

11. Left Lateral Right Lateral Occlusal Notes  Enter occlusal findings here.

12. Maxillary Occlusal Mandibular Occlusal Occlusal Notes  Enter occlusal findings here.

13. Additional Image Additional Notes  Enter any additional findings or concerns here.

14. TMJ & Mandibular Range of Motion  Enter TMJ findings here.

15. Periodontal Findings  Enter periodontal findings here.

16. Periodontal Probing

17. Panorex or FMX Insert Date Here Radiographic Findings  Enter radiographic findings here.

18. Diagnosis & Prognosis  Diagnosis  Type in here.  Prognosis  Periodontal:  Biomechanical/Structural:  Functional:  Esthetic:

19. Summary of Concerns  Enter summary of concerns here.

20. Proposed Treatment Plan  Enter proposed treatment plan here.

21. Proposed Treatment Plan, cont.  Continue proposed treatment plan.

22. Group Treatment Planning

23. Review of Treatment Goals  Enter the goals here.

24. Active Treatment

25. Active Treatment - Phase I  Enter Phase I treatment here.

26. Phase II  Enter Phase II treatment here.

27. Phase III  Enter Phase III treatment here.

28. Phase IV  Enter Phase IV treatment here.

29. Phase V  Enter Phase V treatment here.

30. Phase VI  Enter Phase VI treatment here.

31. Phase VII  Enter Phase VII treatment here.

32. Commentary  Enter commentary here.

33. Post-Treatment Follow-up  Enter post-treatment information and/or commentary here.