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West Virginia Department of Health and Human Resources CHILD CARE PROVIDER MEDICAL REPORT Name of Provider:Date of Birth: (Last)(First)(Middle)Examiner Name and Address: (please print) MEDICAL HISTORY
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How to fill out child care provider medical

01
Gather all necessary medical information such as vaccination records, medical history, and any relevant health conditions of the child care provider.
02
Obtain the required forms for the child care provider medical from the appropriate authorities or agencies.
03
Fill out the personal information section of the form accurately and completely. This may include the provider's full name, date of birth, address, contact information, and social security number or other identification numbers.
04
Provide detailed information about the provider's current health status, including any chronic illnesses, disabilities, or medical conditions that may affect their ability to care for children.
05
Disclose any medications or treatments that the provider is currently undergoing or will require during the course of their employment.
06
Ensure that all the required sections of the form are completed, including any additional forms or documents that may be required.
07
Review the completed form for accuracy and completeness before submitting it.
08
Submit the filled-out child care provider medical form to the appropriate authority or agency as per their instructions.
09
Keep a copy of the filled-out form for your records.
10
Follow up with the authority or agency to ensure that the form has been received and processed.

Who needs child care provider medical?

01
Anyone who intends to work as a child care provider or nanny may be required to fill out a child care provider medical form. This is often a requirement to ensure that the provider is in good health and able to safely care for children.
02
Child care centers, schools, and agencies that hire child care providers may also require these medical forms to comply with health and safety regulations and to assess the provider's suitability for the position.
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Child care provider medical refers to a medical form or documentation that child care providers must complete to ensure they meet health and safety regulations when caring for children.
Child care providers, including those in licensed daycare facilities and family child care homes, are required to file child care provider medical to demonstrate their health status.
To fill out child care provider medical, individuals must provide their personal information, medical history, and any relevant health checks as specified by the licensing authority.
The purpose of child care provider medical is to ensure that child care providers are in good health and do not pose a health risk to the children in their care.
The information that must be reported includes the provider's name, contact details, medical history, immunization records, and results of health screenings.
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