Post Dental Event Report (Treatment Coordinator)

GEID #
Coordinator Position
Coordinator
EOA
Location
Military Branch
Event Start Date
Event End Date
Total Scheduled Treatments
Total Performed Treatments
Pat. No Shows
Total BWX
Total PA's
Total Class III
Total Conversions
Total Vouchers
FedEx #
FedEx Shipping Date

Team Member #1

Member Name
Position
# of PA's
# of Treatments
# of Vouchers
# of Class III
# of Conversions
Events Date Worked
Events Date Worked

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Questions Good Average Poor
How Was The Patient Flow?
Was The Unit Organized ?
How Was The Unit Leadership?
Was The EOA Helpful?

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