LIST OF FORMS 



PAGE 



Exclusion card, Brockton, Massachusetts 22 



Monthly report of medical inspector, Brockton, Massachusetts . . 23 



Exclusion notice with detachable stub, Chicago 25 



Envelope daily report of medical inspector in which are forwarded to 



Board of Health copies of exclusion notices, Chicago . . 26 



Combined directions and prescription, Everett, Mass 28 



Report of sight and hearing tests to superintendents of schools, 



Massachusetts 48 



Snellen chart for testing eyesight 49 



Record of sight and hearing tests, Massachusetts 50 



Notice to parent or guardian of defect of eyes or ears, Massachusetts . 50 



Individual record card. Physical examinations, Chicago, 111. . . 54 



Individual record card. Physical examinations, Pasadena, Cal. . . 55 



Individual record card (Face, Physical Record). Berkeley, Cal. . 56 

 Individual record card (Reverse, Scholarship Record). Berkeley, 



Cal 57 



Notice to parent or guardian, Massachusetts 73 



Post card notification form, Birmingham, Alabama .... 74 



Parent's consent blank, St. Louis, Missouri 75 



Notification of defects and of opportunities for consultation, Oakland, 



California 77 



Notification of defects and of opportunities for consultation, Pasa- 

 dena, California 78 



Notification to parents of school physician's office hours ... 79 

 Notification of nurse's call and of school physician's office hours, Oak- 

 land, California .79 



Agreement between dentists and schools, Muskegon, Mich. . . .123 



Combined directions and prescription for tooth powder, Philadelphia . 1 28 

 Individual dental record Card, Philadelphia (Face) . . . .135 

 Individual dental record Card, Philadelphia (Reverse) . . .' .136 



xix 



