FLUORIDE SUPPLEMENT SUPPLIES Local Health Departments Packing Slip/Order Blank

fluoride supplement supplies local health departments packing slip/order blank __________ water sample kits test tubes, mailing c

FLUORIDE SUPPLEMENT SUPPLIES
Local Health Departments
Packing Slip/Order Blank
__________ Water Sample Kits
Test Tubes, Mailing Cartons
Postage Paid Mailing Labels (LAB-505B)
Parent’s Instructions
(local health departments – please do not submit the LAB-505C with
water sample kits)
__________ Parent’s Consent Forms (OH-9) For Local Health Departments
__________ Guidelines with Dosage Schedules
(Marked copies are sent to you with water test results)
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__________ Protocol and Standing Order for Fluoride Supplementation
For Local Health Departments – one signed copy will cover all children
in program
__________ Fluoride from the Start (formerly “Little Folks”)
__________ Follow-up Chart (Optional)
__________ Bottles of 120 Tablets (0.5 mg. Fluoride)
__________ Dropper Bottles of 1 oz. Fluoride Liquid Drops
__________ Peel-Off Labels for Dropper Bottles
__________ Packing Slip/Order Blank (to order these free supplies)
MAIL OR FAX ORDER TO: FLUORIDE SUPPLEMENT SUPPLIES FULLFILLMENT
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ORAL HEALTH PROGRAM
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DEPARTMENT FOR PUBLIC HEALTH
275 EAST MAIN ST. HS2W-B 75
FRANKFORT, KENTUCKY 40621
Phone: (502) 564-3246 Fax: (502) 696-5159
[email protected]
SHIP SUPPLIES TO: _______________________________________________
_______________________________________________
_______________________________________________
County ________________________ Phone___________
Date: ______________________________ Attn:
___________________________________________
Revised 7/06