Each public health dental hygienist shall maintain data to be reported quarterly to the Massachusetts Department of Public Health's Office of Oral Health, (234 CMR 5.08(7)). Quarterly reports must be submitted by the 15th of the month following the previous quarter as follows: April 15th, July 15th, October 15th and January 15th.

Recently, the Office of Oral Health updated the information each PHDH is required to report. The reporting form(s) is to be filled out by an individual PHDH or a PHDH program. For reporting purposes, a PHDH program is defined as an established entity comprised of one or more PHDH providers. If a report is completed by a PHDH program, each PHDH providing any service at the site must be listed

The reporting form is now accessible electronically. An individual report must be filled out completely. Partially completed forms may not be saved and completed at a future date.

Reporting on Sites Serving Adults (21 yrs of age and older):

To access the electronic Adult Reporting Form go to: http://www.surveymonkey.com/s/6HBT7Z5

Reporting on Sites Serving the Pediatric Population (Under 21 years of age):

To access the electronic Pediatric Reporting Form go to: http://www.surveymonkey.com/s/ZKGC3J2


This information is provided by the Oral Health within the Department of Public Health.