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Click ‘Get Form’ to open it in the editor.
Begin by filling in the child's identifying information, including their name, date of birth, and local residence. Ensure accuracy for smooth processing.
Select the appropriate options for sex and race from the provided choices. This information is essential for demographic purposes.
In the dental section, indicate whether the child has a normal appearance, needs further examination, or has an emergency problem. Use color codes (Green, Yellow, Red) for clarity.
For eye vision and ear hearing sections, mark if the child passed the screening test or needs further professional examination. Include details about who performed the examinations.
Ensure that all signatures are collected from examiners and that dates are filled in accurately to validate the document.
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