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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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