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អតិថិជន


លេខកូដអតិថិជន / PID :

Phone:
Email:

ទន្តបណ្ឌិត / Dentist កាលបរិច្ឆេទ / Invoice Date ថ្ងៃពិនិត្យ / Visit Date 1
# Payment No Invoice No Patient Paid ($) Paid by Dentist Invoice date Paid date
តម្លៃសរុប/Total USD


Email:

អតិថិជន


លេខកូដអតិថិជន / PID :

Phone:
Email:

ព្រៀងវិក្ក័យបត្រ

PRE-INVOICE

ទន្តបណ្ឌិត / Dentist កាលបរិច្ឆេទ / Invoice Date ថ្ងៃពិនិត្យ / Visit Date 1
# ការព្យាបាល លេខធ្មេញ ចំនួន តម្លៃ បញ្ចុះតម្លៃ សរុប
តម្លៃសរុប/Total
Total
Receive Payment
Case Lab Order
No Treatment Teeth Qty
# Partner Contact
Image Size Title Type Display Action
1. Occlusal Contacts
2. Interproximal Contacts
3. Interproximal Contact Shape
4. Occlusion with a closed bite
5. Implant restoration tissue blanching
6. Bridge Pontic Design
7. Unclear Margins
8. Adjacent Tooth Undercut
9. No Bite Enclosed
10. Die Has Undercuts
Confirm Order
# Partner Contact
Attachments
Upload X-rays, photos, or digital scans
Information-restore Order Form Pending confirm order
Information
Creator - Patient -
Delivery date - Upload at -
Partner - Dental Notation FDI
Doctor - Clinic Contact -
Clinic Information - Clinic Address -
Other requirements:
-
Other notes:
Tooth Map
Teeth Service Items Type Method Meterial Shade
Book Appointment
Patient Info
Appointment Info
Appointment Summary
Patient: --
Date & Time: --
Dentist: --
Treatment: --
Add more items
# Item name Free text Qty Unit Price Amount Action