Illinois Dental Exam Form

Illinois Dental Exam Form - PROOF OF SCHOOL DENTAL EXAMINATION FORM Illinois law Child Health Examination Code 77 Ill Adm Code 665 states all children in kindergarten second sixth and ninth grades of any public private or parochial school shall have a dental examination The examination must have taken place within 18 months prior to May 15 of the school year

School Dental Examinations All Illinois children in kindergarten Grade 2 Grade 6 and Grade 9 are required to have an oral health examination This is required for all public private and parochial schools Examinations must be performed by a licensed dentist and he she must sign the Proof of School Dental Examination form

Illinois Dental Exam Form

Illinois Dental Exam Form

217-785-4899 Illinois. • TTY Department (hearing impaired of Public Health, only) 800-547-0466. Division of Oral • Health. Printed by Authority of the State of Illinois. idph.state.il.us.

PROOF OF SCHOOL DENTAL EXAMINATION FORM Illinois law Child Health Examination Code 77 Ill Adm Code 665 states all children in kindergarten and the second sixth and ninth grades of any public private or parochial school shall have a dental examination The examination must have taken place within 18 months prior to May 15 of the school year

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Rev 601 4 2007 PROOF Illinois OF SCHOOL Department DENTAL of EXAMINATION Public Health FORM To be completed by the parent please print Student s Name Last First Middle Birth Date To be completed by dentist Oral Health Status check all that apply No Dental Sealants Present

Fill Free Fillable Forms For The State Of Illinois

Illinois Department of Public Health Division of Oral Health 217 785 4899 TTY hearing impaired use only 800 547 0466 idph state il us IOCI 0600 10 Printed by Authority of the State of Illinois Student s Name Last First Middle Birth Date Month Day Year Address Street City ZIP Code Telephone

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DENTAL EXAMINATION WAIVER FORM Please print am unable to obtain the required dental examination because My child is enrolled in the free and reduced lunch program and is not covered by private or public dental insurance Medicaid All Kids

Illinois Dental Examination Waiver Form Fill Out Sign Online And Download PDF Templateroller

PROOF OF SCHOOL DENTAL EXAMINATION FORM Illinois law Child Health Examination Code 77 Ill Adm Code 665 states all children in kindergarten and the second sixth and ninth grades of any public private or parochial school shall have a dental examination The examination must have taken place within 18 months prior to May 15 of the school year

A licensed dentist must complete the examination, sign and date this Proof of School Dental Examination Form. If you are unable to get this required examination for your child, fill out a separate Dental Examination Waiver Form. This important examination will let you know if there are any dental problems that need attention by a dentist.

Span Class Result Type

PROOF OF SCHOOL DENTAL EXAMINATION FORM Illinois law Child Health Examination Code 77 Ill Adm Code 665 states all children in kindergarten and the second sixth and ninth grades of any public private or parochial school shall have a dental examination The examination must have taken place within 18 months prior to May 15 of the school year

Illinois Dental Exam Form

PROOF OF SCHOOL DENTAL EXAMINATION FORM Illinois law Child Health Examination Code 77 Ill Adm Code 665 states all children in kindergarten and the second sixth and ninth grades of any public private or parochial school shall have a dental examination The examination must have taken place within 18 months prior to May 15 of the school year

School Dental Examinations All Illinois children in kindergarten Grade 2 Grade 6 and Grade 9 are required to have an oral health examination This is required for all public private and parochial schools Examinations must be performed by a licensed dentist and he she must sign the Proof of School Dental Examination form

Printable Dental Examination Form