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Ohio Department of Job and Family Services CHILD MEDICAL STATEMENT For Child Care Centers and Type A Family Child Care Homes Child s Name (print or type) Date of Birth This is to certify all the following:

How to fill out child medical statement

How to fill out a child medical statement:

1. Start by obtaining the necessary form: The child medical statement is typically provided by the child's school or daycare center. Contact the institution to request the form if it has not been provided to you.
2. Review the form: Take the time to thoroughly read through the child medical statement form. Understand the sections that need to be filled out and the information that is required.
3. Personal information: Begin by filling out all the necessary personal information, such as the child's full name, date of birth, address, and contact information. Ensure that this information is accurate and up-to-date.
4. Medical history: Next, provide details about the child's medical history. This may include any pre-existing medical conditions, allergies, medications currently being taken, and any relevant surgeries or illnesses the child has experienced.
5. Immunizations: Include a section dedicated to immunizations. List the vaccines the child has received and their corresponding dates. Ensure that all required vaccines are up to date according to the guidelines provided by the institution.
6. Emergency contacts: Provide contact information for at least two emergency contacts, such as a parent or guardian, with their names, phone numbers, and relationship to the child. These individuals should be reachable in case of any emergency or medical situation.
7. Consent and signature: Read through the consent section carefully and sign the form, giving permission for the school or daycare center to seek medical treatment for the child if necessary. Ensure that all required signatures are provided, and if applicable, have the form signed and dated by a healthcare professional.

Who needs a child medical statement:

1. Schools: Most schools require a child medical statement to ensure the health and well-being of the students. This statement allows the school to be aware of any medical conditions that may require special attention or care.
2. Daycare centers: Daycare centers also require a child medical statement to ensure the safety and well-being of the children in their care. It helps them understand any specific medical needs or allergies that the child may have.
3. Athletic organizations: For children participating in sports or other physical activities, athletic organizations may require a child medical statement. This is to ensure that the child is physically fit to participate and to be aware of any pre-existing conditions that may require special attention or accommodations.

In summary, filling out a child medical statement involves providing accurate personal information, detailing the child's medical history, listing immunizations, providing emergency contacts, and giving consent for medical treatment if necessary. This statement is typically required by schools, daycare centers, and athletic organizations to ensure the health and safety of the child.

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What is child medical statement?

Child medical statement is a document that provides information about a child's medical history, allergies, medications, and any specific medical conditions they may have.

Who is required to file child medical statement?

Parents, guardians, or caregivers of children are required to file child medical statement.

How to fill out child medical statement?

Child medical statement can be filled out by providing accurate and detailed information about the child's medical history, allergies, medications, and specific medical conditions on the designated form.

What is the purpose of child medical statement?

The purpose of child medical statement is to ensure that schools, childcare facilities, or other organizations have necessary information to provide appropriate medical care for children.

What information must be reported on child medical statement?

Information such as child's medical history, allergies, medications, and specific medical conditions must be reported on child medical statement.