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Get Dhhs Head Start Oral Health Form - Children 2023-2024

Ty No State Zip code Current Oral Health Status Does the child have any teeth with untreated decay? Yes (decay) No (decay free) Does the child have any teeth that have previously been treated for decay, including filling , crowns, or extractions? Yes No Are there treatment needs? Yes, urgent Yes, not urgent No treatment needs Oral Health Care Services Delivered During Visit Diagnostic/Preventive Services Yes No Examination: X-rays: Yes No Risk assessment: Yes No Cleaning: Yes No Fluoride va.

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