Download - KM 454e-20190703102512...Part 3 — Oral Health Assessment/Screening HAR-3 REV. 7/2018 Health Care Provider must complete and sign the oral health assessment. To Parent(s) or Guardian(s):

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Page 1: KM 454e-20190703102512...Part 3 — Oral Health Assessment/Screening HAR-3 REV. 7/2018 Health Care Provider must complete and sign the oral health assessment. To Parent(s) or Guardian(s):

Page 2: KM 454e-20190703102512...Part 3 — Oral Health Assessment/Screening HAR-3 REV. 7/2018 Health Care Provider must complete and sign the oral health assessment. To Parent(s) or Guardian(s):

Page 3: KM 454e-20190703102512...Part 3 — Oral Health Assessment/Screening HAR-3 REV. 7/2018 Health Care Provider must complete and sign the oral health assessment. To Parent(s) or Guardian(s):

Page 4: KM 454e-20190703102512...Part 3 — Oral Health Assessment/Screening HAR-3 REV. 7/2018 Health Care Provider must complete and sign the oral health assessment. To Parent(s) or Guardian(s):

Page 5: KM 454e-20190703102512...Part 3 — Oral Health Assessment/Screening HAR-3 REV. 7/2018 Health Care Provider must complete and sign the oral health assessment. To Parent(s) or Guardian(s):

Page 6: KM 454e-20190703102512...Part 3 — Oral Health Assessment/Screening HAR-3 REV. 7/2018 Health Care Provider must complete and sign the oral health assessment. To Parent(s) or Guardian(s):

Page 7: KM 454e-20190703102512...Part 3 — Oral Health Assessment/Screening HAR-3 REV. 7/2018 Health Care Provider must complete and sign the oral health assessment. To Parent(s) or Guardian(s):

Page 8: KM 454e-20190703102512...Part 3 — Oral Health Assessment/Screening HAR-3 REV. 7/2018 Health Care Provider must complete and sign the oral health assessment. To Parent(s) or Guardian(s):

Page 9: KM 454e-20190703102512...Part 3 — Oral Health Assessment/Screening HAR-3 REV. 7/2018 Health Care Provider must complete and sign the oral health assessment. To Parent(s) or Guardian(s):

Page 10: KM 454e-20190703102512...Part 3 — Oral Health Assessment/Screening HAR-3 REV. 7/2018 Health Care Provider must complete and sign the oral health assessment. To Parent(s) or Guardian(s):

Page 11: KM 454e-20190703102512...Part 3 — Oral Health Assessment/Screening HAR-3 REV. 7/2018 Health Care Provider must complete and sign the oral health assessment. To Parent(s) or Guardian(s):

Page 12: KM 454e-20190703102512...Part 3 — Oral Health Assessment/Screening HAR-3 REV. 7/2018 Health Care Provider must complete and sign the oral health assessment. To Parent(s) or Guardian(s):

Page 13: KM 454e-20190703102512...Part 3 — Oral Health Assessment/Screening HAR-3 REV. 7/2018 Health Care Provider must complete and sign the oral health assessment. To Parent(s) or Guardian(s):

Page 14: KM 454e-20190703102512...Part 3 — Oral Health Assessment/Screening HAR-3 REV. 7/2018 Health Care Provider must complete and sign the oral health assessment. To Parent(s) or Guardian(s):

Page 15: KM 454e-20190703102512...Part 3 — Oral Health Assessment/Screening HAR-3 REV. 7/2018 Health Care Provider must complete and sign the oral health assessment. To Parent(s) or Guardian(s):

Page 16: KM 454e-20190703102512...Part 3 — Oral Health Assessment/Screening HAR-3 REV. 7/2018 Health Care Provider must complete and sign the oral health assessment. To Parent(s) or Guardian(s):

Page 17: KM 454e-20190703102512...Part 3 — Oral Health Assessment/Screening HAR-3 REV. 7/2018 Health Care Provider must complete and sign the oral health assessment. To Parent(s) or Guardian(s):

Page 18: KM 454e-20190703102512...Part 3 — Oral Health Assessment/Screening HAR-3 REV. 7/2018 Health Care Provider must complete and sign the oral health assessment. To Parent(s) or Guardian(s):

Page 19: KM 454e-20190703102512...Part 3 — Oral Health Assessment/Screening HAR-3 REV. 7/2018 Health Care Provider must complete and sign the oral health assessment. To Parent(s) or Guardian(s):

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