School Dental Health Record
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D
H
ALTIMORE
OUNTY
UBLIC
CHOOLS
ALTIMORE
OUNTY
EPARTMENT OF
EALTH
T
, MD 21204
B
, MD 21212
OWSON
ALTIMORE
School Dental Health Record
Name of Student:
__________________________________________
Age:
______
Name of School:
__________________________________________
Grade:
______
All students can achieve a healthy mouth, provided they practice protective health habits from
childhood and have the opportunity to benefit from present-day knowledge of dental disease
prevention and control. If your child has not visited your family dentist within the last six
months, we advise you to make an appointment immediately. After the dental appointment, the
signed form should be returned to the school your child will be attending.
Report of Dental Examination:
□
A.
No dental treatment is necessary.
□
B.
All necessary dental treatment has been completed.
□
C.
Treatment is in progress.
Further recommendations:________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
___________________________
____________________________________________
Date
Signature of Dentist
BEBCO 5088-13
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Parent category: Medical