Dc Oral Health 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. Instructions • complete part 1 below.
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• return fully completed and signed form to the student's school/child care facility. Please indicate the ward of your home address, list primary care provider, dental provider, and type of dental insurance. 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. Tb case report form [pdf] vital records 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 district of columbia oral health (dental provider) assessment form parent/guardian instructions: Child’s clinical examination (to be completed by the dental provider)(please use key to document all findings on line next to each tooth) tooth # tooth # tooth # tooth # _______ _______ _______ Web instructions • complete part 1 below. Child’s personal information part 2.
Web all health suite staff collaborate with school personnel to ensure student health needs are met during the school day. Web instructions • complete part 1 below. Please indicate the ward of your home address, list primary care provider, dental provider, and type of dental insurance. Instructions • complete part 1 below. This form is a confidential document. Web district of columbia oral health (dental provider) assessment form parent/guardian instructions: 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 all health suite staff collaborate with school personnel to ensure student health needs are met during the school day. Web oral health assessment form. Child’s clinical examination (to be completed by the dental provider)(please use key to document all findings on line next to each tooth) tooth # tooth # tooth # tooth # _______ _______ _______ Part 1:please complete all sections including child’s race or ethnicity.
