Select the Type of Facility: Describe the type of facility by clicking in the drop-down menu in Column 2 (Block 1a) and selecting
one of the following options:
- Community health centers
- Departments of health
- Migrant health centers
- Other health center
- Private
- Rural health centers
- School - based clinic
Select Type(s) of Oral Health Services Provided: Choose the types of oral health services that are provided at the new dental facility by clicking in the drop-down menu in Column 3 (Block 1c) and selecting
all that apply from the following options:
- Education
- Interprofessional training
- Prevention
- Restoration
Enter # of Patient Encounters: Enter the number of patient encounters at the new facility that occurred during the current reporting period in the textbox in Column 4 (Block 1d).
Select whether this is a Mobile/Portable Facility: Select whether the new site is a mobile/portable site by clicking in the drop-down menu in Column 5 (Block 1e) and choosing
one of the following options: