Illinois Dental Exam Form
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Code 665) states all children in kindergarten and the. To be completed by the parent (please print): Web proof of school dental examination form. Last first middle birth date: Web dental examination waiver form.
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To be completed by the parent (please print): Code 665) states all children in kindergarten and the. Hygienists may request an application for licensure from the department of financial and professional. Please reference the illinois department of public health website to ensure you are using the current form. A licensed dentist must complete the examination, sign, and date this proof.
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