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Kindergarten Oral Health Assessment (KOHA)
Information, forms, and reporting templates for schools and parents/caregivers

KOHA flyer

Children learn better and miss less school days when they have good oral health. California state law requires parents / caregivers of public school kindergartners to have their child complete an oral health assessment and turn it into their school by the start of their kindergarten year. Any first graders who were not enrolled in public school the prior year also need to complete the oral health assessment and turn it in at the start of their first grade year (California Education Code 49452.8)

The screening forms are included in the school enrollment/ registration packet. They must be completed by a licensed dental professional (dentist or dental hygienist).

The Oral Public Health Program collaborates with the San Mateo County Office of Education to ensure all schools and districts are in compliance with this mandate.

If the child is eligible for Medi-Cal / Health Plan of San Mateo (HPSM), but does not yet have a dentist, the parent/caregiver can apply for HPSM Dental coverage through the SMC Health Coverage Unit here.

What parents/ caregivers of public school kindergartners need to do

1. It is recommended that you make a dental appointment for your child during the year before they enter kindergarten, so you can turn in the completed oral health assessment form at the beginning of their kindergarten school year. This will give you plenty of time to get a dental appointment if there are longer wait times.

2. Get the Kindergarten Oral Health Assessment form from your child’s registration packet, from the school office staff, or you can download it in English or Spanish directly from our webpage here (see below).

3. Bring the letter and assessment form in English and in your first language (if applicable) to the dental appointment and have the dentist fill them out.

4. Return the completed form to your child’s school office staff.

Tips for school staff on getting KOHA forms returned

Every year, the required KOHA forms and letters (see below) are included in the Kindergarten registration packet for parents/ caregivers. Make sure the KOHA information is included in the registration information.

1. Let parents/ caregivers know they need to have the KOHA completed by the START of their child’s kindergarten year. While technically parents/ caregivers have until the end of the school year, or May 31st (whichever date comes first), to turn in the oral assessment, the goal is to have all forms returned at the beginning of the child’s kindergarten year. 

2. Include a dental assessment reminder alongside all immunization and health exam requirement reminders to parents/ caregivers at the beginning of the year.

3. At least 3 times a year, have school office staff, wellness staff, or school nurses send a reminder letter to parents/ caregivers of kindergartners about completing the oral health screening. 

4. Have the staff member assigned to collect and track the returned forms call or email parents/ caregivers who have not yet returned the completed screening form. 

5. Include information about the KOHA requirement and a link to the forms on the school webpage, parent portal, newsletters, with PTA members, etc.

6. Share information about the KOHA requirement with Transitional Kindergarten and Kindergarten teachers at the school, and include instructions on how they can find and print the forms.

Tips for school staff on reporting KOHA data into the SCOHR database by July 1st

Public elementary school staff need to collect the forms below and enter the data from them into the System for California Oral Health Reporting (SCOHR) database by July 1st of every school year.

To become a new SCOHR database user:
  • Sign up directly on the SCOHR website here. If there is no space to add a new user, email SCOHR support for help at, or call (866) 762-9170.
  • Or, email: Please include the following information for the new user: First and last name, Title, School, District, Work email, Work phone number, and a preferred Username
Collecting the KOHA forms:

As KOHA forms are turned into school staff throughout the year, assign at least one office, wellness, or nursing staff member to: 

  • Make a 2 sided copy of any of the returned forms: 1) the completed screening, 2) the waiver, and/or 3) the on-site dental screening opt-out letter. 
  • Place all the original forms in the student’s cumulative file. Place all the copies (including copies of any waivers or opt-out letters) in a separate folder labeled “KOHA database reporting, [school year].” The copies in this folder will be given to the person/s assigned to enter the data from them into the SCOHR database.
Tracking and totaling KOHA aggregate data:

As the forms come in throughout the year, set up a system to track the returned forms and to total the aggregate data required in SCOHR for each school. You can use the sample KOHA tracker template provided below, or set up your own system to track and total the data. 

The KOHA data from each school should be entered into SCOHR before staff leave for the summer, or by July 1st at the latest.

SMC KOHA data worksheet

New KOHA aggregate data form

Please contact the Oral Public Health Program at: with any questions about KOHA, or to arrange a training on how to collect and enter the data into the database.

Get children connected to a Health Plan of San Mateo (HPSM) dentist! 

School staff and school nurses have an important role to play in connecting children to dental care. For children on Medi-Cal, go to:

  • HPSM Dental’s Member Services webpage HERE to access the online and downloadable dental provider directories.
  • This HPSM Dental webpage includes a map showing which HPSM Dental clinics accept children.

If needing additional help connecting children to a dentist, contact HPSM Dental’s Member Services:

  • By phone: 1-800-750-4776 or 650-616-2133 Monday–Friday 8:00 a.m. to 6:00 p.m.
  • By email:
  • For children with complex health care needs, send a referral to HPSM’s Care Management program here

All downloadable KOHA forms in English and Spanish: 1) Parent notification letter 2) Screening form 3) Waiver form 4) On-site dental screening opt-out letter 

*All forms were newly updated in 2022 

All new KOHA forms in English and Spanish -  one PDF

KOHA forms in English and Spanish

Individual new KOHA forms in English- Word and PDF

1. SMC Kindergarten Oral Health Assessment Parent/ Guardian Notification Letter - English SMC KOHA Parent Notification Letter SMC KOHA Parent Notification Letter

2. SMC Kindergarten Oral Health Assessment form – English SMC KOHA Screening Form SMC KOHA Screening Form

3. SMC Kindergarten Oral Health Assessment Waiver form – English SMC KOHA Waiver Form SMC KOHA Waiver Form

4. SMC On-Site Dental Screening Opt Out Letter - English SMC On Site School Dental Screening Opt OutSMC On Site School Dental Screening Opt Out

Individual new KOHA forms in Spanish / Español- Word and PDF

1. Carta de notificación sobre la evaluación de salud bucal para alumnos del jardín de niños (kinder / Kindergarten) - Español SMC Parent notification letter- Spanish SMC Parent notification letter- Spanish

2. Formulario de la evaluación de salud bucal para alumnos del jardín de niños (kinder / Kindergarten) - Español SMC Kindergarten Oral Health Assessment form- Spanish SMC Kindergarten Oral Health Assessment form- Spanish

3. Exención del requisito de evaluación de salud bucal para alumnos del jardín de niños (kinder / Kindergarten) - Español SMC KOHA Waiver Form-Spanish SMC KOHA Waiver Form-Spanish

4. Carta de exclusión de la evaluación dental en la escuela - Español SMC On Site School Dental Screening Opt Out Letter- Spanish SMC On Site School Dental Screening Opt Out Letter- Spanish