Oral Health Assessment Form printable pdf download
Dc Oral Health Form. This form is a confidential document. Student information (to be completed by parent/guardian)
Oral Health Assessment Form printable pdf download
• return fully completed and signed form to the student's school/child care facility. The oral health program within the health care access bureau is responsible for assessing and promoting oral health with an emphasis on access to comprehensive oral health services for all dc residents through a dental home. Web oral health assessment form. This form replaces the dental appraisal form used for entry into dc schools, all head start programs, childcare providers, camps, after school programs, sports or athletic participation, or any other district of columbia activity requiring a physical examination. Web oral health assessment form for all students aged 3 years and older, use this form to report their oral health status to their school/child care facility. Part 1:please complete all sections including child’s race or ethnicity. Please indicate the ward of your home address, list primary care provider, dental provider, and type of dental insurance. Take this form to the student's dental provider. The dental provider should complete part 2. Take this form to the student's dental provider.
Instructions • complete part 1 below. • return fully completed and signed form to the student's school/child care facility. Web instructions • complete part 1 below. Child’s personal information part 2. Web oral health assessment form. Web dc oral health (dental provider) assessment form physical health requirement all participating children must comply with physical health standards set forth by the dc department of health. Web district of columbia oral health (dental provider) assessment form part 1. Student information (to be completed by parent/guardian) Web oral health assessment form for all students aged 3 years and older, use this form to report their oral health status to their school/child care facility. This form is a confidential document. Take this form to the student's dental provider.
