Dcps Dental Form. Web universal health certificate use this form to report your child’s physical health to their school/child care facility. Schools must verify every student’s immunization compliance as part of enrollment and attendance (see the school immunization policy for more details).
Dental Exam Form (100/Package)
Web district of columbia oral health (dental provider) assessment form part 1. • return fully completed and signed form to the student's school/child care facility. Part 1:please complete all sections including child’s race or ethnicity. Student information (to be completed by parent/guardian) Web universal health certificate use this form to report your child’s physical health to their school/child care facility. If the child has no dental provider and is uninsured, Schools must verify every student’s immunization compliance as part of enrollment and attendance (see the school immunization policy for more details). Check out how easy it is to complete and esign documents online using fillable templates and a powerful editor. Web instructions • complete part 1 below. Child’s clinical examination (to be completed by the dental provider)date of exam __________________________ (please use key to document all findings on line next to each tooth)
Child’s personal information part 2. For additional information regarding health benefits, please contact our benefits team at dcps.benefits@k12.dc.gov. Student information (to be completed by parent/guardian) Schools must verify every student’s immunization compliance as part of enrollment and attendance (see the school immunization policy for more details). Child’s clinical examination (to be completed by the dental provider)date of exam __________________________ (please use key to document all findings on line next to each tooth) 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. Take this form to the student's dental provider. Web health physicals and oral health assessments are required annually. • return fully completed and signed form to the student's school/child care facility. Web to choose the plan that fits you best, you may review the health benefits plan summary.
