DC Oral Health Assessment Form (DC Health)

DC requires an oral health assessment for students in its schools and child care under D.C. Code 38-602, and DC Health's Oral Health Assessment Form is the record for all students aged 3 and older. It replaces the earlier version used for entry into DC schools, Head Start programs and child care centers. The dental provider reports caries, sealants and care needs.

Who completes it

The parent completes Part 1, the child's information. The dental provider completes Part 2, the oral health status questions, and signs with the examination date and office stamp.

Submitting and payment

How to submit it
The parent takes the form to the dental provider and returns the completed, signed form to the school or child care facility.

Good to know

  • Part 2 separates early care need (untreated caries or other problems needing care before the routine check-up) from urgent care need (pain, abscess or swelling).
  • The dental provider counts primary and permanent teeth affected by untreated or treated caries, and permanent teeth extracted due to caries.
  • Untreated caries means apparent cavitation; stained pits or fissures without enamel breakdown and white-spot lesions do not count.
  • The form records the child's dental insurance type as Medicaid, private insurance, other or none.

Get the official form

Download the current version from the source each time; forms change without notice.

Oral Health Assessment Form

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Who completes the DC Oral Health Assessment Form?

The parent fills in Part 1 with the child's details and school, then takes the form to the child's dental provider. The dental provider answers the Part 2 questions on caries, sealants and care needs, signs it, and adds the examination date and office stamp.

Is the DC oral health form confidential?

Yes. The form is approved by DC Health as a confidential document. Health providers handle it under HIPAA, and DC schools and other providers handle it under FERPA, as the form itself notes.