Illinois Dental Exam Form. Web dental examination waiver form. Web the examination must have taken place within 18 months prior to may 15 of the school year.
Dental Exam Form (100/Package)
Web this form must be submitted with your application. Illinois law (child health examination code, 77 ill. Illinois department of public health, division of oral. Web the newest revised forms must be used. To be completed by the parent (please print): Web state of illinois certificate of child health examination. Code 665) states all children in kindergarten, second,. Web the examination must have taken place within 18 months prior to may 15 of the school year. Web proof of school dental examination form. Web dental examination waiver form.
Oral health status (check all that apply) £ yes. Web dental examination waiver form. Web proof of school dental examination form. To be completed by dentist: Web dental examination waiver form. Web proof of school dental examination form. To be completed by dentist: Health examination form, child : Last first middle birth date: Please reference the illinois department of public health website to ensure you are using the current form. Oral health status (check all that apply) £ yes.
