| ID | Name | Required | List |
|---|---|---|---|
| ORI | Originating Agency Code (ORI) | Y | N |
| NIC | NCIC Number (NIC) | Y | N |
| OCA | Agency Case Number (OCA) | Y | N |
| ID | Name | Required | List |
|---|---|---|---|
| DXR | Dental X Rays Available (DXR) | Y | Y |
| MPA | Dental Models Available (MPA) | Y | Y |
| DRE | Dentists Remarks (DRE) | N | N |
| DCH | All or Unknown (DCH) | N | Y |
| LABEL | ( DCH Field Must Be Blank If Entering Dental Characteristics Below ) | N | N |
| ID | Name | Required | List |
|---|---|---|---|
| T01 | Tooth 01 | N | N |
| T02 | Tooth 02 | N | N |
| T03 | Tooth 03 | N | N |
| T04 | Tooth 04 | N | N |
| T05 | Tooth 05 | N | N |
| T06 | Tooth 06 | N | N |
| T07 | Tooth 07 | N | N |
| T08 | Tooth 08 | N | N |
| T09 | Tooth 09 | N | N |
| T10 | Tooth 10 | N | N |
| T11 | Tooth 11 | N | N |
| T12 | Tooth 12 | N | N |
| T13 | Tooth 13 | N | N |
| T14 | Tooth 14 | N | N |
| T15 | Tooth 15 | N | N |
| T16 | Tooth 16 | N | N |
| T17 | Tooth 17 | N | N |
| T18 | Tooth 18 | N | N |
| T19 | Tooth 19 | N | N |
| T20 | Tooth 20 | N | N |
| T21 | Tooth 21 | N | N |
| T22 | Tooth 22 | N | N |
| T23 | Tooth 23 | N | N |
| T24 | Tooth 24 | N | N |
| T25 | Tooth 25 | N | N |
| T26 | Tooth 26 | N | N |
| T27 | Tooth 27 | N | N |
| T28 | Tooth 28 | N | N |
| T29 | Tooth 29 | N | N |
| T30 | Tooth 30 | N | N |
| T31 | Tooth 31 | N | N |
| T32 | Tooth 32 | N | N |