1. Faculty of Dentistry, Melaka Manipal Medical College, Melaka. GENERAL DENTAL PRACTICE STUDENT WORK REFLECTIONS / PORTFOLIO Name of the Student: ___________________ Year: __________________ Role: Operator/ Assistant

2. Patient Information Name of Patient:Folder Number: Age/Sex: Occupation: Address: Chief Complaint: Past Medical History: Past Dental History: Allergies: Paste Patient Picture Date:

3. Visit -1 A.Examination and Diagnosis: Self-reflection notes: Paste relevant pre-treatment picture Date:

4. Mention Visit – 1/2/3/4 accordingly B.COMMUNICATION/MANNERISMS: Self-reflection notes: Date: Visit :

5. C. CROSS INFECTION CONTROL: Self-reflection notes: D. ERGONOMICS & EXAMINATION TECHNIQUE: Self-reflection notes: Date:

6. E. TREATMENT DONE: Self-reflection notes: Paste relevant post-treatment picture Date:

7. F. DENTAL HEALTH EDUCATION DELIVERY: Self-reflection notes: G. RECORD KEEPING: Self-reflection notes: Paste DHE picture Date:

8. H. STERILIZATION PROCESS Self-reflection notes: I.REFERRAL Self-reflection notes: Date:

9. J. PROFESSIONALISM Self-reflection notes: Date:

10. Summary. NO OF VISITS & DATE WORK DONEROLE OPERATOR/ ASSISTANT STAFF REMARKSSIGNATURE OF STAFF Visit 1 10-10-2015 E&D doneOPERATORNeed to improve in communication and mannerism Visit 2 17-10-2015 Scaling and prophylaxis done. DHE delivered Need to improve in Ergonomics and sterilization protocol Visit 3Class 1 amalgam restoration done restoration done with #46 Not adhering to referral protocol Visit 4Review done