A Patient Information Form must be completed and signed by a parent/guardian for every child to be treated on a Mobile Program truck. The form provides important medical and dental information for treatment and express permission for treatment by the child's parent.guardian.
No treatment can be provided if the Patient Information Form is incomplete or unsigned.
Patient Information Form (.pdf)
Notice of Privacy Practices (.pdf)
Nondiscrimination and Accessibility Statement (.pdf)
Non discrimination | አማርኛ |
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