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[DOCX File]Dental Health Certificate - P-12 : NYSED
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I understand that by signing this form I am consenting for the child named above to receive a basic oral health assessment. I understand this assessment is only a limited means of evaluation to assess the student’s dental health, and I would need to secure the services of a dentist in order for my child to receive a complete dental examination with x-rays if necessary to maintain good oral ...
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[DOC File]SAMPLE - P-12 : NYSED
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Name of School Dental Exam Information for Registered Nonpublic Nursery Schools and Kindergartens. Dear Parents: As you know, our preschool, nursery school, and/or kindergarten program(s) are voluntarily registered with the New York State Education Department.
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[DOC File]St
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Dental Examination. Name of Student_____ Date_____ Dear Doctor, Your patient attends Concordia Learning Center at St. Joseph’s School for the Blind. Please complete the following: This certifies that I have examined the above named student and: ___ All necessary dental work is completed.
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[DOC File]Oral Health Notification Letter - Health Services & School ...
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The law specifies that the assessment must be done by a licensed dentist or other licensed or registered dental health professional. Take the attached Oral Health Assessment/Waiver Request form to the dental office, as it will be needed for your child’s check-up.
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[DOC File]SAMPLE REPORT TEMPLATE - Intersocietal
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All bony structures of the maxillofacial region were included in the exam. ... IAC Dental CT Sample Report 1. NOTE: This is a SAMPLE only. Protocols submitted with the application MUST be customized to reflect current practices of the facility. Title: SAMPLE REPORT TEMPLATE
dental examination form

Kentucky Dental Screening/Examination Form for School Entry
OAS/DSS Kentucky Dental Screening/Examination Form for School Entry KDESHS005. Kentucky law, KRS 156.160(i), requires proof of a dental screening or examination by a dentist, dental hygienist, physician, registered nurse, advanced registered nurse practitioner, or physician assistant.
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[DOC File]Mandatory Exams Required For Entry On 1st Day Of School ...
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No physical exam required, unless a sports physical is needed. Sixth. Dental exam or waiver . Physical exam, with immunizations current** TDap Booster and Meningococcal vaccine. Any student participating in sports must have a physical each year. If any/all of the exams are completed over the summer, you can bring the form(s) to registration.
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[DOC File]COUNTY CONNECTIONS DENTAL EXAM FORM
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DENTAL EXAM FORM. Please complete and Return to: Stacy Stoneburner, Muskingum Valley Preschool, 205 N. 7th St. Zanesville, OH. Ohio 43701 Ph: 740-452-4518 Fax: 740-455-6702. Child’s Name (print or type) Date of Birth Parent’s Name. School Site Attending Is …
school dental examination form pdf

[DOC File]Oral Health Assessment Form - Health Services & School ...
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A California licensed dental professional operating within his scope of practice must perform the check-up and fill out Section 2 of this form. If your child had a dental check-up in the 12 months before he/she started school, ask your dentist to fill out Section 2.
dental school form pdf

[DOC File]School Dental Form - Pennsylvania Department of Health
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1ST EXAM Yes No 2ND EXAM Yes No 3RD EXAM Yes No 4TH EXAM Yes No 5TH EXAM. Yes No OTHER. Yes No NAME OF STUDENT _____ DENTAL FINDINGS – Check Applicable Items. Grade Date EXAMINED OR EVALUATED BY Prophylaxis SPECIAL PROJECTS (Specify) FLUORIDE Oral Evaluation. Passed/
printable dental exam form

Dental exam form for school