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DVbubbleForm indd Letterhead - ncdhhs 2026

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4.6 out of 5

56 votes

The document titled 'Into the Mouths of Babes' is a dental screening and varnish project encounter form designed for recording patient information, dental health conditions, and oral healthcare practices for children. It includes sections for demographic data, teeth condition assessment, intraoral soft tissue pathology, oral healthcare questions, and procedures performed during the visit. The form aims to facilitate the collection of data related to children's dental health and ensure appropriate referrals and education are provided.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the 'Date of Visit' and 'Patient DOB' in the designated fields. Ensure accuracy for proper record-keeping.
Fill in the 'Patient Name', 'Medicaid ID #', and demographic details such as 'Race' and 'Sex'. Use the provided options to select appropriately.
In the section labeled 'Teeth and Conditions Present', indicate how many teeth are present and perceived cavities by coloring in the corresponding bubbles.
For intraoral soft tissue pathology, check 'Y' or 'N' and specify any conditions that apply by marking them clearly.
Complete the oral healthcare questions, ensuring to mark responses accurately regarding daily dental care practices.
Finally, review all entries for completeness before signing as a provider. Ensure all necessary referrals are noted.

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2007	4.6 Satisfied (56 Votes)

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