Dear Parent/Guardian:
The Jordan Valley Mobile Dental Clinic will be visiting our school January 16th-19th, 2018. Jordan Valley Dental will be providing free onsite dental services to qualifying students. The program is available to students K-4th (as well as the siblings of those students who qualify), 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 fill out ALL 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.
Appointments are limited so please return completed forms to the school nurse ASAP. 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 417-759-2558
Sincerely
Mandy Miller, RN
Elementary School Nurse
Please see the attached LETTER and REGISTRATION FORM for further details