日期2012.09.21医生患者刘继松文广日王世国吴荣发张立忠马照东孙越张玉福蔡艳国高文杰李光雨耿占友赵树范朴永南高长河梁伟诊断残根右下6拔除残根右下6及左上6拔除残根右上47右下2左上47左下3拔除残根右上26右下456拔除残根左上7左下1拔除残根右下7左下8拔除残根右下78拔除侧龋右下8拔除残根右下6拔除残根右上6左上6拔除残根右上67左下4567拔除残根右上467拔除残根左下1235678右下46拔除残根右下1238拔除残根右上67右下23567左下7拔除残根右上56右下7拔除处置费西药费一次性盘701102702309013013090701102701503501503101502680患方签字合计（元）备注3.73.73.73.73.73.73.73.73.73.73.73.73.73.73.73.759.23.53.53.53.53.53.53.53.53.53.53.53.53.53.53.53.55677.2117.2277.2237.297.2137.2137.297.277.2117.2277.2157.2357.2157.2317.2157.22795.2复诊复诊林治成合 计医生签字
