Get Seals Child Level Data

The SEALS Child Level Data form is essential for collecting important information about a child's dental care and health. This guide provides a clear, detailed approach to help you fill out this form accurately and efficiently.

Follow the steps to complete the SEALS Child Level Data form.

1. Click the ‘Get Form’ button to access the SEALS Child Level Data form and open it in your preferred online document editor.
2. Begin by filling out the program name. For example, enter 'DOH-Volusia' in the designated field.
3. Provide the event or site name in the corresponding field, ensuring it accurately represents the location of care.
4. Enter the patient's first and last name in the appropriate fields. For the sex field, select '0' for male and '1' for female.
5. Fill in the grade of the child using '0' for kindergarten or another appropriate code.
6. Complete the date of birth (DOB) field followed by the age of the child.
7. In the race/ethnicity section, check all applicable categories for the child, such as 'White,' 'Black/African American,' or 'Hispanic.'
8. Indicate if the child has special health care needs by selecting '0' for No or '1' for Yes.
9. Detail the child's Medicaid/SCHIP status using the appropriate codes: '0' for Medicaid, '1' for SCHIP, '2' for neither, or '99' for unknown.
10. In the screening section, mark the appropriate boxes based on the dentist's observations related to dental decay, missing teeth, or other treatments as needed.
11. Obtain and sign the sealant prescriber’s signature and date as required on the form.
12. Proceed with sections on fluoride treatment received and follow-up appointments. Mark teeth as indicated and record comments as appropriate.
13. Finally, review the entire form for accuracy. Once completed, you have options to save your changes, download, print, or share the completed SEALS Child Level Data form.

Complete your SEALS Child Level Data form online today for accurate health tracking and support.