Illinois Dental Exam Form

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To be completed by dentist: Last first middle birth date: A licensed dentist must complete the examination, sign, and date this proof of. Illinois law (child health examination code, 77 ill. Code 665) states all children in kindergarten and the.

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Last first middle birth date: Web dental examination waiver form. To be completed by the parent (please print): Code 665) states all children in kindergarten and the. Oral health status (check all that apply) £ yes.

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