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Board of County Commissioners Broward County Florida HUMAN SERVICES DEPARTMENT Bureau of Children and Family Services Child Care Licensing and Enforcement Section PHYSICIAN S STATEMENT OF GOOD HEALTH FOR CHILD CARE PERSONNEL Name Expires 2 years from above date Address IN MY OPINION THIS INDIVIDUAL IS PHYSICALLY QUALIFIED TO CARE FOR CHILDREN AND IS FREE OF ALL COMMUNICABLE DISEASES. I AM NOT AWARE OF ANY BEHAVIOR THAT MAY BE INJURIOUS TO CHILDREN. Physician s Signature Physician s Stamp.
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To fill out the is of all communicable, follow these steps:
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Start by gathering all the necessary information about the communicable disease.
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Identify the name of the disease and any associated codes.
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Determine the date of diagnosis or onset of symptoms for the individual.
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Collect information about the source or mode of transmission.
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Note down the duration of communicability or infectious period.
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Include details about any preventative measures taken or recommended.
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Document any treatment or intervention received by the individual.
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Include information about any complications or outcomes related to the disease.
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Infectious disease report form for recording communicable diseases.
Healthcare providers, medical facilities, and public health agencies are required to file the infectious disease report form.
The infectious disease report form can be filled out online or submitted in person at the local health department.
The purpose of the infectious disease report form is to track and monitor the spread of communicable diseases in a community.
Information such as the type of disease, date of diagnosis, and demographic information of the patient must be reported on the infectious disease report form.
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