Dental SurveyPlus 2@7222222 2223333 2322232322222222223$3. OLD PCT CODEOLD PCT@@o$ 4. EXAMINER'EXAMINER@@$5. SCHOOL NAME' SCHOOL NAME@@(!5$6. SCHOOL POSTCODE"7SCHOOL POSTCODE1@@ $13. EXAMINATION TYPENb $7. DATE OF EXAMINATIONTUh   DATE OF EXAM1Dateb@?19$8. CHILD IDENTITY NUMBERB CHILD IDENT NOChild identity~.A$9. MONTH / YEAR OF BIRTH}$10. POST CODE$ CHILD POSTCODE1@@ 21sExamination and School Details 1 Child's Details<'Ethnicity Details +1Consent and ExaminationFJ Caries Experience Chart3Enter Details of Caries Experience Information Here678t0$N5R91234CTXYv  876edcbaabcde678876edcbaabcde6788888888888888880000000000000000000000000000000000000000000000000088888888888888888888888888888800000000000000000000000000000000000000000000000000888888888888888 $15. ABSCESS / SEPSIS 1 Other Details(}$ 17. SPARE 1SPARE 1@@((}$ 18. SPARE 2SPARE 2@@((} $ 19. SPARE 3SPARE 3@@( 1#Optional DetailsOcc$ 1. LA CODEP-eLA CODE@@v EXAMINATIONChoose one of the following0 - Main 1 - Repeat 2 - Training 3 - Absent4 - Child Refused  9SEPSISAbcess or Sepsis present 0 - Absent 1 - Present  .  BIRTH MONTHMonth of Birth 010203040506070809101112  ,c/  BIRTH YEAR Year of Birth200120022003  '1 Spare Details(Zn2$16. ETHNIC CODEI]5$11. SAMPLE SUB-GROUPH`6SUBGROUPSurvey sub-group0 - Main BASCD Sample1 - Additional Sample A2 - Additional Sample B3 - Additional Sample C4 - Additional Sample D5 - Additional Sample E  p7$12. CONSENT STATUSq8CONSENTChoose one of the following0 - Form not returned1 - Consent refused 1st post2 - Consent refused 2nd post3 - Consent given 1st post4 - Consent given 2nd post  #:$AANN6P;$NAA&<$AANN2&=$NAAw>$2. NEW PCT CODEx-? NEW PCT CODE@@(@$#5-YEAR-OLDS 2007/08 NATIONAL SURVEYZsrA ETHNIC CODEChoose one of the following A - White B - Mixed C - Indian D - PakistaniE - BangladeshiF - Other AsianG - Black CaribbeanH - Black AfricanI - Black Other J - ChineseK - Ethnic other AL - Ethnic other BM - Ethnic other C  D$14. PLAQUE ASSESSMENT 1EOral CleanlinessFPLAQUEChoose one of the following0 - Teeth appear clean1 - Little plaque visible2 - Substantial plaque visible 9 - Assessment could not be made  "B7KSCHOOL POSTCODE2@@,`L CHILD POSTCODE2@@MD!9m