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
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