Iowa requires children newly enrolling in kindergarten or ninth grade to submit a Certificate of Dental Screening to their school, and Iowa HHS says this form is the only acceptable one. The provider records the screening date and one treatment need: no obvious problems, requires dental care, or requires urgent dental care. The certificate is invalid unless every field is complete.
The screening provider completes the screening section and signs with credentials: for kindergarten, a dentist, dental hygienist, physician, nurse, ARNP or PA; for ninth grade, a dentist or dental hygienist only.
Download the current version from the source each time; forms change without notice.
Certificate of Dental Screening
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Only a licensed dentist or dental hygienist. For kindergarten, a dentist, dental hygienist, physician, nurse, advanced registered nurse practitioner or physician assistant may screen. Out-of-state providers are allowed, and the provider checks one credential box on the certificate.
No. The certificate states that a screening does not replace an exam by a dentist and that children should have a complete examination by a dentist at least once a year. Regional I-Smile coordinators help students who need a screening or follow-up care.