AZ DHS Emergency Information and Immunization Record Card 2018-2026 free printable template

CDC/SGH# or name: Arizona Department of Health Services Bureau of Child Care LicensingEmergency, Information and Immunization Record Card Child's Name:Updated:Date Enrolled:Home Address (#, Street,

How to fill out AZ DHS Emergency Information and Immunization

How to fill out AZ DHS Emergency Information and Immunization Record

1. Obtain the AZ DHS Emergency Information and Immunization Record form from the Arizona Department of Health Services website or local health department.
2. Fill in the child's personal information including name, date of birth, and address at the top of the form.
3. Provide emergency contact information, including names and phone numbers of individuals to be contacted in case of an emergency.
4. Record the child's medical history, including any allergies, medical conditions, or medications they are currently taking.
5. Fill in immunization records, listing all vaccinations the child has received, along with dates of administration.
6. Review the completed form for accuracy and ensure all necessary sections are filled out.
7. Sign and date the form to confirm the information is complete and accurate.
8. Keep a copy for your records and submit the original to the appropriate school or daycare facility.

Who needs AZ DHS Emergency Information and Immunization Record?

1. The AZ DHS Emergency Information and Immunization Record is needed by parents or guardians of children attending school or daycare in Arizona to provide important health and emergency information.

People Also Ask about

How do I transfer my EMT license to Arizona?

Arizona does not have reciprocal agreements with any other states; therefore, you cannot transfer your certification to Arizona. You are required to have current and valid National Registry and reside in Arizona.

What is the Department of licensing and regulation in Arizona?

The Office of Licensing and Regulation (OLR) is the licensing and regulatory authority that licenses and monitors Foster Homes, Congregate Care Agencies, Child Placing Agencies, and Adoption Agencies across the State of Arizona.

Who administers license law in Arizona?

Licensing & Regulation. The Certification and Licensing Division develops and administers certification and licensing programs for the Arizona Supreme Court.

How do I get my paramedic license in Arizona?

In order to train as a paramedic, a student must have completed training at the Emergency Medical Technician (EMT) level or higher. The program director may accept evidence of 1) licensure 2) national certification or 3) completion of a program that is Department-approved or equivalent.

Who regulates hospitals in Arizona?

The Arizona Department of Health Services promotes and protects the health of Arizona's children and adults. We strive to set the standard for personal and community health through direct care, science, public policy, and leadership.

What does Arizona DHS stand for?

Arizona Department of Health Services.

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What is AZ DHS Emergency Information and Immunization Record?

The AZ DHS Emergency Information and Immunization Record is a document used to record vital health information and vaccination history for individuals, particularly children, to ensure their health needs are met during emergencies.

Who is required to file AZ DHS Emergency Information and Immunization Record?

Parents or legal guardians of children attending school or childcare facilities in Arizona are typically required to file the AZ DHS Emergency Information and Immunization Record.

How to fill out AZ DHS Emergency Information and Immunization Record?

To fill out the AZ DHS Emergency Information and Immunization Record, individuals should provide personal details such as the child's name and birth date, emergency contact information, medical conditions, and a comprehensive list of vaccinations received.

What is the purpose of AZ DHS Emergency Information and Immunization Record?

The purpose of the AZ DHS Emergency Information and Immunization Record is to ensure that essential health information is readily available in case of a medical emergency, facilitating timely and appropriate care.

What information must be reported on AZ DHS Emergency Information and Immunization Record?

The information that must be reported includes the child's full name, date of birth, emergency contacts, medical conditions, allergies, and a record of immunizations received, including dates and types of vaccines.