Table 1. Case history proforma.

Date and Time -	Registration no.-
Name -	Age and Sex -
Religion -	Marital status -
Occupation -	Mobile no.-
Address-
Chief complaint –
History of presenting illness-
Past medical history –
Family history -
Personal history –
Habit history -
General examination –
Temperature –	Pulse rate-
Respiratory rate -	BP-
SpO2-	Pallor-
Icterus-	Cyanosis-
Clubbing-	Oedema-
Lymphadenopathy -
Extraoral examination-
Facial symmetry-	Lips-
TMJ-	Intraoral examination

Soft tissue examination-

Buccal mucosa

Labial mucosa-

Tongue-

Palate-

Floor of mouth-

OSF features – No. of bands- Burning sensation- Blanching of oral mucosa- Difficulty in swallowing- Inability to whistle /blow- Dry mouth- Mouth opening Grade -

Hard tissue examination-

Teeth present-

Teeth missing –

Wasting disorder-

Systemic examination – Liver examination

Inspection-

Palpation-

Percussion-

Auscultation-

Provisional diagnosis-

Investigation – Liver function test

Final diagnosis-

Patient sign -                                                                     Doctor sign-