HN Unit Orthodontics Log Sheet Tracking Form

HN Unit Orthodontics – Log sheet tracking form

Tick and date as signed off by assessor

Fixed 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Fit 5 At least 2 cases with orthodontist De-bond 5 At least 2 cases with orthodontist Adjustment 20 At least 5 cases with orthodontist Removable 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Active 5 At least 2 cases with orthodontist Passive 5 At least 2 cases with orthodontist Functional 10 At least 5 cases with orthodontist I can confirm that 50 log sheets have been completed successfully demonstrating competency in assisting in the above range of orthodontic procedures.

I can confirm that 50 log sheets have been completed successfully demonstrating competency in assisting in the above range of orthodontic procedures.

Candidate details & signature

Name & contact address Qualification (inc. GDC number Signature date)

Assessor’s details & signature

Name & contact address Qualification (inc. GDC number Signature date)

Log Sheet Supervising Registrants(s)

Name & contact address Professional Role GDC number Signature