Toothbrushing ATTENDANCE

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OH FORM 3 - Daily Tooth Brushing Progress Report

Municipality/City: _______________________
Day Care Center: _______________________ ̷
Month/Year ________________________

Exposure Days

AGE
NAME 1 2 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

____________________________
Day Care Worker

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