School Dental Screening

Dear Parent, Guardian or Caretaker,

During a school dental screening, a registered dental hygienist found that your child has a dental condition that requires immediate treatment by a dental provider. The Parent Notification Form (PNF – yellow form) must be completed and returned to Ottawa Public Health within 20 business days, as per the mandated dental screening program of the Ontario Ministry of Health - Requirement #5 of the Ontario Public Health Standards.

How to complete this form:

• Section 1 – Client is already enrolled in Healthy Smiles Ontario OR is able to pay for treatment
• Section 2 – Client would suffer financial hardship if they had to pay for treatment

Information collected on this encrypted form is used for the purposes of managing dental screening services under sections 5 and 7 of the Health Protection and Promotion Act (as amended) and the Ontario Public Health Standards (2018). The protection of your personal health information is of critical importance to Ottawa Public Health. We take all necessary steps to safeguard personal health information. Questions concerning the collection and use of this information should be directed to the Supervisor of Dental Health Promotion, Ottawa Public Health, 400-1580 Merivale Rd., Ottawa, ON, tel.: 613-580-2424, ext 26376.

Remember before uploading the Parent Notification Form (PNF) below:

• Do not forget to sign the form if you want to enroll your child in the Emergency and Essential Services Stream of the Healthy Smiles Ontario program.
• Complete all required information to avoid processing delays.