Namaste, Dr. Gupta 👋

PRO Dental Lab Doctor Portal

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Dental Lab Work Authorisation

Crown & Bridge, Zirconia, Implants & Prosthetics Requisition

Step 1: Input Details

Patient & Case Information

Patient Full Name (In Block Letters) *

Age

Gender

Case Type

Order Date

Required Date

No. of Days

dentistry Crown & Bridge Restoration Type

Restoration Type *

Fabrication Style *

diamond Material System & Brand

Shade & Clinical Contacts

VITA Shade

Stump Shade

Occlusal Contact

Proximal Contact

Pontic Design (For Bridges)

Occlusal Clearance Action

Tooth Selection (FDI)

Selected: None

Maxilla (Upper Jaw)

Mandible (Lower Jaw)

dentistry Impression & 3D Scan Method *

Select source

electric_moped Field Partner DLV-01 will be dispatched for pickup

Free Lab Service

Preferred Pickup Time Slot *

Pickup Handover Note

Enclosed Items (Quantities)

Upper Impression

Lower Impression

Wax / PVS Bite

Tray with model

Upper Model

Lower Model

Implant Abutment / Analog

psychology

Clinical Notes & Smart Auto-Filler

Quick Presets:

1-Tap Clinical Chips (Tap to Insert & Auto-fill) Auto-populates Form

Work Authorisation Slip

Official prescription record for dental appliance fabrication

Patient Name: --

Date: --

Required Date: --

WORK DETAILS:

Sl. No : --

✁ ----------------- CUT HERE -----------------

PRO DENTAL LAB PVT. LTD.

Destination Centre, Magarpatta City, Hadapsar, Pune, Maharashtra - 411028

Ph : +91 98765 43210 • info@prodentallab.in • ISO 13485:2016 Certified

Order Date : --

Required Date : --

No of Days : --

DOCTOR'S NAME : --

Clinic's Name : --

Address : --

Phone : --

BAR CODE

*PDL-WA-2026*

Sl. No :

● VERIFIED CASE

PATIENT NAME : (IN BLOCK LETTERS)

Age : -- | Gender : --

Case Type: -- [ ] Repeat [ ] Thesis

DENTAL LAB WORK AUTHORISATION

CROWN & BRIDGE **

[✓] Crown

[ ] Bridge

[ ] Inlay/Onlay/Overlay

[ ] Veneer

[ ] Maryland Pontic

[ ] Post & Core

[ ] Endocrown

[ ] Rest

[ ] Wing

[ ] 3/4th Crown

[ ] Loop Connector

[ ] Post Crown

PRO DENTAL LAB ZIRCONIA

Platinum Plus [M] [PFZ] [CB]

Premium Plus [M] [PFZ] [CB]

Classic [M] [PFZ] [CB]

Ultra Plus [M] [PFZ] [CB]

BruxCare [M] (Post. upto 4 units)

Solid Plus (15 Yrs) [M] (Selected)

(M- Monolithic, PFZ- Porcelain fused to Zirconia, CB- Cut Back)

IPS e.max & LAVA (3M ESPE)

e.max Press [ ] Staining [ ] Layering

e.max CAD [ ] Staining [ ] Layering

Lava Premium [M] [PFZ] [CB]

Lava Translucent [M] [PFZ] [CB]

Lava Essential [M] [PFZ] [CB]

PEEK & COMPOSITE

JUVORA [ ] LC-Facing [ ] LC-Full

Bio HPP [ ] [M] [ ] LC-Facing [ ] LC-Full

LIGHT CURE COMPOSITE (Metal Free):

[ ] Crown [ ] Inlay [ ] Onlay/Overlay [ ] Veneer [ ] Rest

METAL / CERAMIC & TEMPORARY

[ ] DMLS (CAD/CAM)

[ ] Nova

[ ] Magna

[ ] Precious Alloy

[ ] Ornamental Gold **

[ ] NPG ** (Non Precious)

[ ] Titanium ** [Milled] [DMLS]

[ ] Full Metal

[ ] PFM-Facing

[ ] PFM

[ ] LC*-Facing

[ ] LC*-Full Coverage

[ ] Ceramic Coating

[ ] Composite Coating

PRO DENTAL PERMAPRINT LUMINER: [ ] Partial [ ] Full

PROVISIONAL / TEMPORARY:

[ ] PMMA Milled [ ] 3D Printed [ ] Heat Cure [ ] Self Cure

* Only with metal/metal ceramic ** No Ceramic Layering * Light Cure Composite ** Mandatory, if Applicable

IMPLANT PROSTHESES **

Crown & Bridge :

[ ] Screw [ ] Cement [ ] C/Access Hole

Implant Supported Overdenture :

Fixed: [ ] Ti Milled [ ] Nova

Frame work for Overdenture :

[ ] PEEK [ ] Ti DMLS [ ] DMLS [ ] Nova

Hybrid Denture :

[ ] Screw [ ] Cement [ ] Provisional

Prime Frame Work:

[ ] Ti Milled [ ] PEEK

Std Hybrid Frame:

[ ] Ti Milled [ ] PEEK [ ] Nova

Acrylic: [ ] Plus [ ] Impact [ ] Inject [ ] Inject Pro | [ ] BPS (Ivoclar)

Framework for C&B (Malo):

[ ] Ti Milled Prime [ ] Ti Milled [ ] Ti DMLS [ ] DMLS

[ ] With Die [ ] Without Die (*As applicable)

SHADE **

Cervical : A2

Middle : A2

Incisal : A2

Shade Guide : VITA Classical

Anterior & Posterior Shade Tooth Diagram

(*As applicable)

Discoloration* : [ ] Yes [✓] No

Stump Shade : [✓] Vital [ ] Non vital [ ] Composite [ ] Metal

Gingival Shade* : [ ] Yes [✓] No

Stains and Effect : [ ] Enamel Cracks [ ] White Spot [ ] Other

Occlusal Staining : [ ] No [✓] Light [ ] Medium [ ] Dark

Digital Photos: WhatsApp: 9539377711 | info@prodentallab.in

MISCELLANEOUS

[ ] Digital Smile Design

[ ] Digital Mockup

[ ] Digital Stump Prep

[ ] 3D Printed Model

[ ] CAD Image

[ ] Putty Index

[ ] Vacuum Formed Template

[ ] Light Cure Special Tray

[ ] Customized Abutment

[ ] Implant Bite Block

[ ] Implant Special Bite

[ ] Jig Trial

[ ] Teeth Setting Trial

[ ] Frame Work w/ Teeth Trial

[ ] Frame Work Trial

[ ] Mockup

Is this a full mouth rehabilitation case? : Yes: [ ] Planned [ ] On Going | [✓] No

TOOTH SELECTION (FDI) TARGET RESTORATION

Tooth No: -- Target Tooth Preparation

[✓] Individual [ ] Joined [ ] Lingual Metal Collar

If no occlusal clearance :

[✓] Frame / Metal Island

[ ] Reduction Coping

[ ] Adjust Antagonist

[ ] Antagonist to be restored later

If interproximal space is less: [ ] Adjust adjacent [ ] Expose frame

Occlusal Contact: [✓] Perfect

Occlusal Contacts: Perfect, Infra, Under

✓

Proximal Contact: [✓] Point

✓

Pontic Design: Modified Ridge Lap [✓]

Pontic Designs: Sanitary, Ridgelap, Modified, Bullet, Ovate

✓

ENCLOSED ITEMS (number against item)

[ ] Upper Model: -

[ ] Lower Model: -

[✓] Upper Impression: 1

[✓] Lower Impression: 1

[ ] Tray with model: -

[✓] Wax / PVS Bite: 1

[ ] Additional Model: -

Notes:

Ensure tight interproximal contacts, relieve occlusion by 0.5mm on distal cusp.

Signature of Doctor :

Dr. Prakash Gupta

Reg. No: MH-DEN-48921

Doctor Seal

Executive : Rahul Sharma Emp. Code : EMP-408 PN : PN-102

For Office Use Only

Parcel Time & Date: 22-09-2026 11:30 AM Unpacked By: QC-L2

Component Received: All Verified & Accepted

Dental appliance information: This is a custom made dental device which is intended for the exclusive use by the patient. This device has been manufactured to satisfy the design, information, property and characteristics specified by the dentist for the above patient provided by the dentist. All goods are supplied in a non-sterile condition unless otherwise stated and should not be subjected to extremes of heat and cold. It is recommended that the product shall be stored in a clean and safe environment if not used immediately.

auto_fix_high Clear Aligners & Orthodontic Lab Authorisation

Digital 3D Staging, Clear Aligners, Thermoformed Splints & Ortho Appliances

Step 1: Clinical Configuration

Patient & Order Information Physical Slip Counterfoil

Patient Full Name (In Block Letters) *

Age

Gender

Order Date

Required Date

Case Type

New Case Repeat Case Thesis Other

Estimated Turnaround

Standard Ortho 3D Staging

psychology Skeletal Base & Dentition (Page 2)

Skeletal Base Relation *

Class I Class II Class III

Dentition Phase *

Permanent Mixed Dentition

linear_scale Treatment Plan Specifications (Upper vs Lower Arch)

Upper Arch (Maxilla) Arch 1

Non-Extraction (Expansion / Alignment) Extraction (Mark teeth on chart) IPR Allowed on Upper Arch

Lower Arch (Mandible) Arch 2

Non-Extraction (Alignment / Proclination) Extraction (Mark teeth on chart) IPR Allowed on Lower Arch

folder_shared Records & Photographs Submission WhatsApp: +91 81389 49435 | Email: support@dentcarealigners.com

Diagnostic Record	Via WhatsApp	Via Email	Attach Directly
Clinical Profile Photographs			Included Below
IOPA X-Rays
OPG (Orthopantomogram)
Lateral Cephalogram
CBCT 3D DICOM

cloud_upload

Upload Intraoral Scans (Upper & Lower Arches + Bite)

Formats: STL, PLY, OBJ, or ZIP archive

grid_view Tooth Selection Chart (Permanent & Deciduous)

Mode: Marked: None

Permanent Teeth (Adult)

Deciduous / Primary Teeth (51-85 for Mixed Dentition)

Enclosed Items (Quantities) Mention number against each item

Upper Impression

Lower Impression

Upper Model

Lower Model

Wax / PVS Bite

Tray with Model

Additional Model

Previous Aligner

Doctor's Clinical Instructions & Setup Notes

Official Aligner Work Authorisation Slip

1:1 Authentic Digital Replica • Verification & Export Ready

Verified Slip

Patient Name: SHRUTI DESHMUKH

Date: 2026-09-25 | Required Date: 2026-10-05

Work Details: PRO Clear Aligners • Full Dual Arch 3D Staging

SL. NO: ALN/WA-2026-7842

PRO DENTAL LAB PVT. LTD.

PDL

PRO DENTAL LAB PVT. LTD.

NAS ROAD, MAGARPATTA CITY, HADAPSAR, PUNE - 411028
Ph: +91 98765 43210 • info@prodentallab.in • ISO 13485:2016 Certified

SL. NO : ALN/WA-2026-7842

||| | |||| | || |||||

Order: 2026-09-25 Days: 10 Days

DOCTOR'S NAME : DR. PRAKASH GUPTA

Clinic's Name : Dr Prakash Gupta Multispeciality Dental Clinic

Address : Destination Centre, Magarpatta, Pune

Phone : +91 98765 43210

Patient Name : (In Block Letters) Age: 24 | Female [✓]

[✓] New Case [ ] Repeat Case [ ] Thesis

Chief Complaint

Aesthetic correction of anterior crowding and midline alignment.

Habits

[ ] Bruxism

[ ] Tongue Thrusting

[ ] Thumb Sucking

H/o Long Term Medication

[✓] No [ ] Yes

Medication: -

Periodontal Condition

[✓] Good [ ] Weak [ ] Compromised

High Frenal Attachment

[✓] No [ ] Yes

Dentition

[✓] Permanent [ ] Mixed

Upper Midline To Facial Midline

[✓] Centred

Prior Orthodontic Treatment

[✓] No [ ] Yes

Skeletal Base

[✓] Class I [ ] Class II [ ] Class III

Treatment Plan

Upper:

[ ] Extraction [✓] Non-Extraction [✓] IPR

Lower:

[ ] Extraction [✓] Non-Extraction [✓] IPR

Records Checklist WA / Email

Photograph: WhatsApp [✓]

IOPA: -

OPG: WhatsApp [✓]

LAT.CEPH: -

CBCT: Email [✓]

WA: +91 81389 49435 | Email: support@dentcarealigners.com

Mandatory Profile Photo Views 1:1 Replica

Target Tooth Chart Full Arch

Permanent: 11-48 • Deciduous: 51-85

Standard Setup (Non-Extraction)

ENCLOSED ITEMS (number against item)

[✓] Upper Impression: 1

[✓] Lower Impression: 1

[✓] Wax / PVS Bite: 1

[ ] Upper Model: -

[ ] Lower Model: -

[ ] Tray with Model: -

[ ] Additional Model: -

[ ] Aligner: -

[✓] Soft Copy Photos / OPG / CBCT Attached

Notes:

Align upper anterior crowding with mild arch expansion. Perform IPR up to 0.25mm on 13-23 contacts if needed. Maintain Class I molar relationship.

Signature of Doctor :

Dr. Prakash Gupta

Reg. No: MH-DEN-48921

Doctor Seal

Executive : Rahul Sharma Emp. Code : EMP-408 PN : PN-102

For Office Use Only

Parcel Time & Date: 25-09-2026 11:30 AM Unpacked By: QC-L2

Component Received: All Verified & Accepted

Settings & Account

Doctor profile, app updates & lab preferences

Dr. Prakash Gupta

Dr Prakash Gupta Multispeciality Dental Clinic

badge BP Code (Doctor ID) BP-260821

call Registered Mobile +91 98765 43210

location_on Clinic Address Pune, Hadapsar

meeting_room Floor & Landmark 1st Floor, F11-F12 (Above Axis Bank ATM)

my_location Clinic GPS Pin 18.5144, 73.9298

GPS Pin Active

edit_note Edit Profile & Details

Doctor Profile Photo

Doctor Full Name *

Mobile Number *

BP Code (Doctor ID)

Clinic / Hospital Name *

Clinic Full Address *

Floor / Unit & Landmark (For Delivery Boy)

Helps delivery riders reach your clinic doorstep without calling reception.

pin_drop Interactive Clinic Location Map

Click anywhere on map or drag pin

Quick:

pin GPS Coordinates:

Practice Category

account_balance Lab Bank Account & UPI Settlement

Beneficiary Name PRO DENTAL LAB PVT LTD

Bank Name & Branch HDFC Bank Ltd., Hadapsar

A/C Number 50200049182391

IFSC Code HDFC0000182

UPI ID (VPA) prodentallab@hdfcbank

shield_lock Security, PIN & Clinic Privacy

fingerprint

Biometric / Fingerprint Unlock

Instant secure login using device biometric security

4-Digit Master PIN Lock

Protects financial ledger & digital Rx case submissions

visibility_off

Clinic Privacy Mode (Mask Balances)

Hide financial balance on dashboard when staff uses device

local_shipping Lab Pickup & Logistics Preferences

Preferred Daily Impression Pickup Window

Default Case Workflow

Priority Express Case Alert

Notify senior ceramist immediately when an urgent case is submitted

tune Lab Notifications & Preferences

WhatsApp Case Tracking

Receive dispatch & delivery updates via WhatsApp

3D CAD High-Precision Lighting

Enable dynamic studio shadow in 3D viewer

Auto FIFO Invoice Receipts

Auto download payment slip on clearing bill

Monthly PDF Statement on Email

Auto-send monthly tax ledger on 1st of every month

verified_user ISO 13485:2016 check_circle ISO 9001:2015

• •

Payments & Ledger

Statement balances, settlement & financial ledger

Net Outstanding Balance

₹ 0.00

account_balance_wallet

Pending Bills: 0 Invoices Reward Points: 0 Pts

check_circle

No Open Invoices

All bills are settled and clear. Invoices will automatically appear here once restorations are dispatched from the lab.

Namaste, Rajesh 👋

UHID: PDP-1001 • 38 yrs, Male (B+)

local_hospital

Dr. Gupta Dental Clinic & Implant Center

Dr. Amit Gupta, B.D.S., M.D.S.

call chat

Next Visit event

28 Sep, 11:00 AM

Crown Fitment #16

Active Rx medication

1 Active Rx

4 Prescribed Meds

Balance account_balance_wallet

₹5,500 Due

₹5,000 Paid

Imaging radiology

3 X-Ray Scans

RVG & OPG on File

Confirmed Next Visit In 3 Days

Sep 28

Permanent Crown Fitment (Tooth #16)

Monday, 28 Sep 2026 • 11:00 AM • Operatory 1

Treating Surgeon: Dr. Amit Gupta

call Call Clinic

dentistry Clinical Treatment Plan

67% Complete

✓

Root Canal Treatment (Molar #16)

3 Canals obturated hermetically

Done

⏳

Zirconia Monolithic Crown (Tooth #16)

Fabricated at Pro Dental Lab

In-Progress

✓

Ultrasonic Scaling & Polishing

Full mouth prophylaxis completed

Done

account_balance_wallet Account & Payment Summary

Total Billed ₹10,500

Paid Amount ₹5,000

Balance Due ₹5,500

prescriptions Active Prescriptions (Rx)

💊

Augmentin 625 Duo (1x2)

Amoxicillin + Clavulanic Acid • 5 Days

Morning & Night

💧

Ketorol-DT 10mg (SOS)

Dispersible Pain Relief Tablet

As Needed

warning Patient Medical Notice

Medical History: Hypertension (Well-controlled on medication).
Allergy Note: Mild sensitivity to Sulfa group drugs (Avoided in prescriptions).

support_agent Need Help or Have Discomfort?

If you experience swelling or severe sensitivity, contact Dr. Gupta Dental Clinic immediately:

call Call Clinic chat WhatsApp

Namaste, Rahul 👋

Rider ID: DLV-01

Deliveries

Assigned patient orders for clinic dispatch

0 Orders

two_wheeler

Rahul Patil

Verified

Field Logistics & Clinic Operations

badge Rider ID DLV-01

call Mobile Number +91 98220 00000

electric_moped Vehicle Reg. No MH-12-DE-4412 (Electric)

inventory_2 Equipment Issued Thermal Box + QR Scanner

monitoring Lifetime Operational Performance

Deliveries 142

Pickups 89

3D Scans 34

support_agent Lab Central Dispatch Support

Logistics Desk Helpline +91 98765 43210

call Call Desk

tune Rider Preferences

Dispatch Push Alerts

Receive instant sound notifications for new pickups

High-Contrast Map Routing

Optimized bright turn-by-turn navigation on field

verified_user ISO 13485:2016 check_circle ISO 9001:2015

Description of Goods	GST Rate	Quantity	Amount
OUTPUT CGST @ 6%	6%		₹ 627.70
OUTPUT SGST @ 6%	6%		₹ 627.70
Round Off			₹ 0.00
Total		1 Nos	₹ 11,717.00

HSN/SAC	Taxable Value	Central Tax		State Tax		Total Tax Amount
HSN/SAC	Taxable Value	Rate	Amount	Rate	Amount	Total Tax Amount
Total	₹ 10,461.61	6%	₹ 627.70	6%	₹ 627.70	₹ 1,255.40

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Namaste, Dr. Gupta 👋

Products

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My Orders

Payment

Warranty Card

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Dental Lab Work Authorisation

Patient & Case Information

dentistry Crown & Bridge Restoration Type

diamond Material System & Brand

Shade & Clinical Contacts

Tooth Selection (FDI)

dentistry Impression & 3D Scan Method *

Clinical Notes & Smart Auto-Filler

Work Authorisation Slip

CROWN & BRIDGE **

IMPLANT PROSTHESES **

SHADE **

MISCELLANEOUS

ENCLOSED ITEMS (number against item)

auto_fix_high Clear Aligners & Orthodontic Lab Authorisation

Patient & Order Information Physical Slip Counterfoil

psychology Skeletal Base & Dentition (Page 2)

linear_scale Treatment Plan Specifications (Upper vs Lower Arch)

vital_signs Clinical Examination & Patient Habits

folder_shared Records & Photographs Submission WhatsApp: +91 81389 49435 | Email: support@dentcarealigners.com

grid_view Tooth Selection Chart (Permanent & Deciduous)

shield TMJ Appliances & Thermoformed Splints Page 1 Specification

hardware Orthodontic Wirework & Functional Appliances Page 1 Wire & Expansion

Enclosed Items (Quantities) Mention number against each item

Official Aligner Work Authorisation Slip

PRO DENTAL LAB PVT. LTD.

Chief Complaint

Habits

H/o Long Term Medication

Periodontal Condition

High Frenal Attachment

Dentition

Upper Midline To Facial Midline

Prior Orthodontic Treatment

Skeletal Base

Treatment Plan

ENCLOSED ITEMS (number against item)

Digital Warranty Hub

No Digital Warranties Issued Yet

Settings & Account

Dr. Prakash Gupta

account_balance Lab Bank Account & UPI Settlement

shield_lock Security, PIN & Clinic Privacy

local_shipping Lab Pickup & Logistics Preferences

tune Lab Notifications & Preferences

Payments & Ledger

No Open Invoices

calendar_month Filter Statement Period

Namaste, Rajesh 👋

Permanent Crown Fitment (Tooth #16)

dentistry Clinical Treatment Plan

account_balance_wallet Account & Payment Summary

prescriptions Active Prescriptions (Rx)

support_agent Need Help or Have Discomfort?

My Visits & Appointments

Permanent Crown Fitment & Occlusal Check

Past Clinical Visits

Prescriptions & Medicines

Acute Irreversible Pulpitis #16

Diagnostic Dental Radiographs

Pre-Operative Intraoral RVG (Tooth #16)

Post-Obturation RVG (Tooth #16)

Digital Orthopantomogram (Full Mouth OPG)