GKAS NYC 2020 Exam Information Site 5

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SITE 5, PS 112 - 535 East 119 Street

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Age *

Does the student currently have pain in their mouth? *

Yes

Are clinical caries present? *

Yes

Are restorations present? *

Yes

Does the student have sealants? *

Yes

Recommendation: *

No treatment recommended- the child's hard and soft tissues appear to be visually healthy and there is no apparent reason for the child to be seen before the next routine dental checkup

Early/routine care needed- pt does not appear to be receiving routine dental care or presents with white spot lesion or suspected decay in one or more teeth.

Urgent care- obvious tooth decay is present in one or more teeth, the child is experiencing pain, or there is evidence of infection or injury

IF URGENT CARE NEEDED (REQUIRED): Student Name, Grade, and School (not site)

Today patient was provided (check all that apply) *

Dental Screening

Fluoride Varnish

A Referral

必須

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