Dear Parent/Guardian:
The Jordan Valley Mobile Dental Clinic will be visiting our school starting October 29th through the 31st. Jordan Valley Dental will be providing free onsite dental services to qualifying students. The program is available to students K-12th, who have active Medicaid.
Students who qualify will be given an initial exam and a treatment plan will then be determined by the dentist. Details of the exam, the treatment plan, and a consent to treat form will be sent home with your child. The consent to treat form MUST be returned to the school nurse the following day in order for your child to receive treatment. We ask that if your child’s treatment includes extractions or otherwise invasive treatment that you be present during the procedure. The school nurse will also have a copy of your child’s treatment plan. You are encouraged to call with any questions/concerns prior to treatment.
If you would like for your child to receive dental services, please print out and fill out ALL 3 pages of the attached forms/patient information, front and back, which includes the consent and agreement statement that must be signed by a parent/guardian. IMPORTANT: make sure to fill in your child’s MEDICAID NUMBER. If you do not have access to a computer or printer, please contact your student’s building school nurse for a hard copy to be sent home with them.
Appointments are limited so please return completed forms to the school nurse ASAP, and no later than October 25th. Priority is given to students who have the greatest dental needs, as well as those who return their paperwork promptly.
Please contact the school nurse with questions at 417-759-2555
Sincerely,
Mandy Miller, RN Elementary School Nurse Ext. 215
Brandy Cantwell, RN Middle School/High School Nurse Ext. 426