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IA School-Age Child Health Form/Parent Statement of Health 2009 free printable template

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IOWA SCHOOL-AGE CARE — HEALTH STATUS — PARENT STATEMENT Parent/Guardian please complete pages 1 and 2. Child s name Child s birthdate Name of school Grade Parent #2 name Parent #1 name School
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How to fill out IA School-Age Child Health Form/Parent Statement of Health

01
Obtain the IA School-Age Child Health Form/Parent Statement of Health from your child's school or the appropriate health department.
02
Start by filling out the child's personal information, including name, date of birth, and school.
03
Provide details about the child's medical history, including any chronic illnesses or conditions.
04
List any medications the child is currently taking, including dosages and frequency.
05
Include information about allergies, both food and environmental, and any reactions the child has experienced.
06
Indicate if the child has had any recent hospitalizations or surgeries.
07
Complete the immunization history section, ensuring that all vaccines are up to date according to state requirements.
08
Answer any additional questions regarding the child's health habits, such as sleep, nutrition, and physical activity.
09
Review the completed form for accuracy and completeness.
10
Submit the form to the appropriate school or health authority as instructed.

Who needs IA School-Age Child Health Form/Parent Statement of Health?

01
Parents or guardians of school-age children.
02
Schools requiring health information for enrollment or participation in activities.
03
Health care providers assessing the child's health status.
04
Local health departments or authorities for record-keeping purposes.
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The IA School-Age Child Health Form/Parent Statement of Health is a document used to assess the health status of children enrolled in school programs in Iowa. It collects health information necessary for the school to ensure the well-being of the student.
Parents or guardians of school-age children who are enrolling in school programs in Iowa are required to file the IA School-Age Child Health Form/Parent Statement of Health.
To fill out the IA School-Age Child Health Form/Parent Statement of Health, parents should complete all sections of the form, providing detailed information about the child's health history, immunizations, and any ongoing medical conditions or treatments.
The purpose of the IA School-Age Child Health Form/Parent Statement of Health is to provide schools with critical health information needed to support the physical and mental well-being of students and to comply with state health requirements.
The IA School-Age Child Health Form/Parent Statement of Health must report information such as the child's personal and contact details, immunization history, any allergies, chronic health conditions, medications, and other relevant health information.
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