Get the free Medical Statement - Child Development Council

OCFS-LDSS-4433 (Rev. 5/2014) FRONT NEW YORK STATE OFFICE OF CHILDREN AND FAMILY SERVICES CHILD IN CARE MEDICAL STATEMENT To Be Completed By Licensed Physician, Physician s Assistant or Nurse Practitioner

How to fill out medical statement - child

How to fill out a medical statement - child:

1. Start by writing the child's full name, date of birth, and contact information at the top of the form.
2. Provide the name and contact information of the child's primary healthcare provider.
3. Indicate the purpose of the medical statement, whether it is for school, sports, or another specific activity.
4. Include a detailed medical history of the child, including any chronic conditions, allergies, medications, or previous surgeries.
5. Document the child's immunization history, including dates and types of vaccines received.
6. If the child has any current medical conditions or ongoing treatments, provide all relevant details.
7. Specify any physical limitations or restrictions that the child may have, and whether any accommodations are necessary.
8. Include emergency contact information, such as the names and phone numbers of parents or guardians who can be reached in case of an emergency.
9. Finally, sign and date the medical statement, and make a copy for your records.

Who needs a medical statement - child?

1. Schools often require a medical statement for various purposes, such as enrolling in a new school, attending field trips, or participating in physical education classes.
2. Sports organizations typically mandate a medical statement to ensure the child is physically fit to participate in the chosen sport.
3. Summer camps and other recreational programs may request a medical statement to ensure the child's safety and well-being during their stay.
4. Some travel destinations, such as certain countries or campsites, may require a medical statement to ensure the child is up to date on necessary vaccinations or does not pose a risk to public health.

Remember, it is always best to consult with the specific institution or organization that requires the medical statement for detailed instructions on how to complete and submit the form correctly.

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What is medical statement - child?

A medical statement for a child is a documentation of the child's medical history, conditions, and any necessary medical treatments.

Who is required to file medical statement - child?

Parents or legal guardians of the child are typically required to file the medical statement for the child.

How to fill out medical statement - child?

The medical statement for a child can be filled out by providing all relevant medical information about the child, including past illnesses, current conditions, medications, and any allergies.

What is the purpose of medical statement - child?

The purpose of a medical statement for a child is to ensure that caregivers, teachers, and medical personnel are aware of the child's medical needs and can provide appropriate care.

What information must be reported on medical statement - child?

Information such as the child's name, date of birth, medical conditions, allergies, current medications, and emergency contact information must be reported on the medical statement for a child.