MDHHS-6280, CERTIFICATE OF DENTAL SCREENING

Michigan Department of Health and Human Services (MDHHS)

(New 8-25)

Parents/guardians: Your child received a dental screening. Dental screening is required for kindergarteners by the Michigan Public Health Code, Public Act 368 of 1978, MCL 333.9316. Present this certificate of screening when enrolling your child into kindergarten. Retain a copy for your health records.

Pass	Refer; follow-up with a dentist required

Screening does not replace the need for routine dental care. Routine dental checkups are recommended every 6 months.

Child’s Name	Screening Date

Agency/Local Health Department	Phone Number