Sioux City Community Schools -

According to the State of Iowa Health and Human Services, the intent of the School Dental Screening law is to improve the oral health of Iowa children – finding cavities or other problems early, lowering treatment costs, and teaching children how to care for their teeth and gums through proper brushing and choosing healthy foods and drinks. Having good oral health makes children better learners in school.

Iowa law requires students entering kindergarten AND 9th-grade to provide proof of a dental screening to their school.

If your child has had a dental exam or screening in the past 12 months but has not yet turned in the Certificate of Dental Screening form linked below, please ask the provider who completed the exam or screening to fill out the Certificate as soon as possible. Once completed, submit the form to your child's school.

Dental Screening Certificate Form (Form to be Completed by Health Provider)
Dental Screening Exemption Form

Anaphylaxis Individual Health Plan Form
Anaphylaxis Individual Health Plan for Non-Food Allergies Form
Asthma Individual Health Action Plan Form
Diabetes Individual Health Plan Form
Questionnaire for Parents of a Child with a Seizure Disorder Form
Special Dietary Request Form

Authorization for Administration of Asthma or Other Airway Constricting Disease Medication Form
Authorization for Medication or Procedure Administration Form
Certificate of Immunization Form (Form to be Completed by Health Provider)
Certificate of Immunization Exemption Form – Medical (Form to be Completed by Health Provider)
Certificate of Immunization Exemption Form – Religious
IDHP Master Index Card (Form to be Completed by Health Provider)
Provisional Certificate of Immunization (Form to be Completed by Health Provider)

Vision Screening Certificate Form (Form to be Completed by Health Provider)