Loading
Form preview picture

Get School Dental Screening Form

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. This evidence shall be presented to the school no later than January 1 of the first year that a five 5 or six 6 year old is enrolled in public school* Student Name Last Birth date First // Test Type check one Middle Gender 0 Male 1 Female Parent or Guardian Name Screening Exam Screener s Name Relationship Screener s Address Address City Phone Number School Date of Exam/Screening // Screener s Signature Professional affiliation Please check one Untreated Decay Check one Dentist Dental Hygienist 0 No untreated cavities Physician Assistant LHD Registered 1 Untreated cavities 1 Treated cavities APRN Physician Pattern of Early Childhood Cavities Check one Treatment Urgency 0 No Early Childhood Cavities 1 Early Childhood Cavities Present 0 No obvious problem 1 Early dental care needed 2 Referral for Urgent Care NOTE Comment required if marked* OH-12 rev 4/2010 Comments Nurse with KIDS Smiles training. 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. This evidence shall be presented to the school no later than January 1 of the first year that a five 5 or six 6 year old is enrolled in public school* Student Name Last Birth date First // Test Type check one Middle Gender 0 Male 1 Female Parent or Guardian Name Screening Exam Screener s Name Relationship Screener s Address Address City Phone Number School Date of Exam/Screening // Screener s Signature Professional affiliation Please check one Untreated Decay Check one Dentist Dental Hygienist 0 No untreated cavities Physician Assistant LHD Registered 1 Untreated cavities 1 Treated cavities APRN Physician Pattern of Early Childhood Cavities Check one Treatment Urgency 0 No Early Childhood Cavities 1 Early Childhood Cavities Present 0 No obvious problem 1 Early dental care needed 2 Referral for Urgent Care NOTE Comment required if marked* OH-12 rev 4/2010 Comments Nurse with KIDS Smiles training.

How It Works

KRS rating
4.8Satisfied
30 votes

Tips on how to fill out, edit and sign Cavities online

How to fill out and sign Urgency online?

Get your online template and fill it in using progressive features. Enjoy smart fillable fields and interactivity. Follow the simple instructions below:

Legal, business, tax and other e-documents need higher of compliance with the legislation and protection. Our documents are regularly updated in accordance with the latest amendments in legislation. Additionally, with us, all the details you include in your School Dental Screening Form is protected against loss or damage through cutting-edge encryption.

The following tips will allow you to fill out School Dental Screening Form easily and quickly:

  1. Open the form in our full-fledged online editing tool by hitting Get form.
  2. Fill out the necessary fields which are marked in yellow.
  3. Hit the green arrow with the inscription Next to move on from field to field.
  4. Go to the e-autograph solution to put an electronic signature on the template.
  5. Add the date.
  6. Double-check the whole document to be sure that you have not skipped anything important.
  7. Hit Done and download the resulting template.

Our service allows you to take the whole procedure of submitting legal papers online. As a result, you save hours (if not days or weeks) and eliminate unnecessary costs. From now on, submit School Dental Screening Form from the comfort of your home, place of work, and even while on the move.

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.

Referral FAQ

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.

Keywords relevant to School Dental Screening Form

  • aprn
  • KDESHS005
  • KRS
  • untreated
  • screener
  • affiliation
  • referral
  • hygienist
  • cavities
  • Practitioner
  • enrolled
  • urgency
If you believe that this page should be taken down, please follow our DMCA take down processhere.
Ensure the security of your data and transactions

USLegal fulfills industry-leading security and compliance standards.

  • 
                            VeriSign logo picture

    VeriSign secured

    #1 Internet-trusted security seal. Ensures that a website is free of malware attacks.

  • Accredited Business

    Guarantees that a business meets BBB accreditation standards in the US and Canada.

  • 
                            TopTenReviews logo picture

    TopTen Reviews

    Highest customer reviews on one of the most highly-trusted product review platforms.