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Kindergarten Oral Health Assessment (KOHA)
Information, forms, and reporting templates for school districts

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California Education Code 49452.8 requires all public school kindergartners in the state and any first grader who was not enrolled in public school the prior year to receive a kindergarten oral health assessment ( “KOHA” screening). The screening must be completed by a licensed dental professional (dentist or dental hygienist) and turned into the child’s school by May 31st.

Below are the forms* San Mateo County (SMC) public elementary schools with kindergartens must send to parents/ guardians in the annual enrollment packet.

*All forms were newly updated in 2022 

ENGLISH

1. SMC Kindergarten Oral Health Assessment Parent/ Guardian Notification Letter - English SMC KOHA Parent Notification Letter_2022

2. SMC Kindergarten Oral Health Assessment form – English SMC KOHA Screening Form_2022

3. SMC Kindergarten Oral Health Assessment Waiver form – English SMC KOHA Waiver Form_2022

4. SMC On-Site Dental Screening Opt Out Letter - English SMC On Site School Dental Screening Opt Out_2022

ESPAÑOL- SPANISH

1. Carta de notificación sobre la evaluación de salud bucal para alumnos del jardín de niños (kinder / Kindergarten) - Español SMC Parent notification letter- Spanish_2022

2. Formulario de la evaluación de salud bucal para alumnos del jardín de niños (kinder / Kindergarten) - Español SMC Kindergarten Oral Health Assessment form- Spanish_2022

3. Exención del requisito de evaluación de salud bucal para alumnos del jardín de niños (kinder / Kindergarten) - Español SMC KOHA Waiver Form-Spanish_2022

4. Carta de exclusión de la evaluación dental en la escuela - Español SMC On Site School Dental Screening Opt Out-Spanish_2022