California Education Code Section 49452.8 requires proof of an oral health assessment for each child in kindergarten, or in first grade if not previously enrolled in public school, by May 31 of that school year. Dentists and other dental professionals meet this two-page form at a child's check-up. The school keeps the original, and districts report aggregate data without children's names through the System for California Oral Health Reporting (SCOHR).
A California licensed or registered dental health professional completes Section 2, Oral Health Data Collection, and signs it with a California license number. The parent or guardian fills out Section 1, and Section 3, follow-up to urgent care, is completed by whichever entity is responsible for follow-up.
The parent or guardian enters the child's first and last name, middle initial and birth date, home address, school name, teacher, grade and the year the child starts kindergarten, plus their own name and the child's gender and race or ethnicity. The opening note tells parents that a California licensed dental professional must do the check-up and fill out Section 2, and that a check-up in the last 12 months counts.
Section 2 is filled out by a California licensed dental professional. Enter the assessment date as month, day and year. For Untreated Decay (Visible Decay Present), check Yes or No. The form's important note says to consider each box separately and mark each box, so answer this item on its own rather than inferring it from the caries question that follows.
Check Yes if there is visible decay and/or fillings present, and No only if there is no untreated decay and no fillings. A footnote on the form spells out this rule. Because fillings count, a child whose decay has all been treated is still Yes for caries experience while untreated decay is No.
Check one of three levels. No obvious problem found. Early dental care recommended, for caries without pain or infection, or when the child would benefit from sealants or further evaluation. Urgent care needed, for pain, infection, swelling or soft tissue lesions. An urgent finding triggers Section 3, where the responsible entity records parent notification and follow-up.
Sign the form, enter your California license number and date it. The form says a California licensed dental professional must do the check-up and fill out Section 2, and the license number beside the signature is how the form records that. The date here is the date you sign, separate from the assessment date above.
When urgent care is needed, the entity responsible for follow-up records the date the parent was notified of the urgent dental need, the date of any follow-up appointment, and whether the child received the needed treatment: yes, no or I don't know. If the answer is no, that entity is encouraged to check back with the parent. The form adds that schools must keep student health information private and may use it only for purposes related to the child's health.
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Oral Health Assessment Form (Kindergarten Oral Health Assessment)
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A California licensed or registered dental health professional completes Section 2 and signs it with a California license number. The parent or guardian fills out the child's information in Section 1. If the child had a dental check-up in the last 12 months, that dentist can complete Section 2.
The form must be returned to the school no later than May 31 of the child's first year in public school, which is kindergarten, or first grade for a child not previously enrolled. CDPH describes proof of the assessment as due on an annual basis by May 31, and schools must notify parents of the requirement.
Yes. CDPH announced KOHA forms in Spanish, Chinese Simplified, Chinese Traditional, Korean, Tagalog and Vietnamese, and links to them on the COHTAC website at UCSF. The English form on CDPH's site carries a July 2021 date, and CDPH says the updated KOHA forms took effect July 1, 2022.
The form defines it for you. Check Yes for caries experience if there is untreated decay or fillings present. Check No only if there is no untreated decay and no fillings. Untreated decay is recorded separately, so a child with fillings but no active decay is No for untreated decay and Yes for caries experience.