Each public health dental hygienist shall maintain data to be reported to the Massachusetts Department of Public Health's Office of Oral Health, (234 CMR 5.08(7)). Required reports must be submitted twice per year, on January 31st and July 31st, according to the timeframes outlined below:

  • For sites completed between January 1st and June 30th reports are due July 31st
  • For sites completed between July 1st and December 31st reports are due January 31st of the following year

*For example – if a site is started in May, but is not finished until August – reports for this site are not due until January 31st of the following year.

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

An individual report must be filled out completely. Partially completed forms may not be saved and completed at a future date.

To access the electronic Adult Reporting Form go to: http://mdph.checkboxonline.com/PHDH-Adult-Site-Reporting-Form.aspx

To access the electronic Pediatric Reporting Form go to: http://mdph.checkboxonline.com/School-Pediatric-Site-Reporting-Form.aspx


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