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Kentucky Dental Screening/Examination Form for School EntryAugust 2010-2025

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The document is a Kentucky Dental Screening/Examination Form required for school entry, mandating proof of a dental screening or examination for children enrolling in public school. It includes sections for student information, screener details, and assessments of dental health, such as untreated and treated decay, along with urgency for treatment. The form must be completed by qualified professionals and submitted by January 1 of the child's first school year.

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Click ‘Get Form’ to open the Kentucky Dental Screening/Examination Form in the editor.
Begin by entering the student's name, birth date, and gender in the designated fields. Ensure accuracy as this information is crucial for school records.
Fill in the parent or guardian's name, relationship, address, city, and phone number. This section helps schools contact guardians if necessary.
Indicate the school name and date of enrollment. This information is essential for tracking compliance with state requirements.
Complete the screener's details including their name, address, phone number, and screening date. This verifies who conducted the dental examination.
Check the appropriate boxes regarding untreated decay and treated decay based on the child's dental health status.
Select any patterns of early childhood cavities and treatment urgency as applicable. Comments are required if urgent care is needed.
Finally, ensure that the screener signs the form and indicates their professional affiliation before submitting it to the school.

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See more Kentucky Dental Screening/Examination Form for School EntryAugust 2010 versions

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Versions	Form popularity	Fillable & printable
2011	4 Satisfied (29 Votes)
2010	4.8 Satisfied (113 Votes)

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