CT Adult Medical Statement for Child Care 2017 free printable template

CONNECTICUT OFFICE OF EARLY CHILDHOOD DIVISION OF LICENSING ADULT MEDICAL STATEMENT for CHILD Release check one of the following boxes: Family Child Care Home Applicant Family Child Care Home Staff

How to fill out CT Adult Medical Statement for Child Care

How to fill out CT Adult Medical Statement for Child Care

1. Obtain the CT Adult Medical Statement form from the relevant child care agency or website.
2. Fill in the child's personal information including their full name, date of birth, and address.
3. Provide the parent's or guardian's contact information.
4. Indicate the child's medical history, including any allergies or chronic conditions.
5. List any medications the child is currently taking and their dosages.
6. Ensure a licensed physician completes and signs the medical statement.
7. Double-check all information for accuracy and completeness.
8. Submit the completed form to the child care provider according to their submission guidelines.

Who needs CT Adult Medical Statement for Child Care?

1. Parents or guardians who are enrolling their child in a childcare program in Connecticut.
2. Children who require documentation of their health status for participation in child care facilities.

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What is CT Adult Medical Statement for Child Care?

The CT Adult Medical Statement for Child Care is a form that documents an adult's health status and any medical considerations relevant to their participation in child care services.

Who is required to file CT Adult Medical Statement for Child Care?

Individuals who are applying for or are involved in child care programs in Connecticut may be required to file the CT Adult Medical Statement to ensure they meet health requirements.

How to fill out CT Adult Medical Statement for Child Care?

To fill out the CT Adult Medical Statement for Child Care, individuals should provide personal health information, complete mandated sections regarding medical history, and obtain necessary signatures from a certified healthcare provider.

What is the purpose of CT Adult Medical Statement for Child Care?

The purpose of the CT Adult Medical Statement for Child Care is to ensure the health and safety of children in care by documenting the health status of adults interacting with them.

What information must be reported on CT Adult Medical Statement for Child Care?

The CT Adult Medical Statement must report information such as medical history, current health conditions, vaccinations, and any relevant medical treatments, along with verification from a healthcare professional.