Ocfs Medical Form

Ocfs Medical Form - Web this form may be used to meet the consent requirements for the administration of the following: 7/2005) front new york state office of children and family services medical statement of child in childcare to be completed by licensed physician, physician’s assistant or nurse practitioner name of child: 06/2019) new york state office of children and family services child in care medical statement to be completed by licensed physician, physician assistant or nurse practitioner name of child: Yes no * a copy of the well visit can be attached to this form a signature is required. Request for forms and publications to: / / date of examination: 04/2016) page 3 of 4 is consent of child's parent or guardian for routine medical care on file? If the only role is a household member, complete ony the front page. / / immunizations required for entry into day care Web office of children and family services child in care medical statement to be completed by licensed physician, physician assistant or nurse practitioner name of child:

If the only role is a household member, complete ony the front page. Immunizations required for entry into day care medical exemption Yes no * a copy of the well visit can be attached to this form a signature is required. 06/2019) new york state office of children and family services child in care medical statement to be completed by licensed physician, physician assistant or nurse practitioner name of child: 04/2016) page 3 of 4 is consent of child's parent or guardian for routine medical care on file? A signature is required on both sides of this form. Only those staff certified to administer medications to day care children are permitted to do so. / / immunizations required for entry into day care Request for forms and publications to: Web office of children and family services child in care medical statement to be completed by licensed physician, physician assistant or nurse practitioner name of child:

If the only role is a household member, complete ony the front page. Ocfs forms and publications unit. Yes no * a copy of the well visit can be attached to this form a signature is required. A signature is required on both sides of this form. Immunizations required for entry into day care medical exemption Request for forms and publications to: 06/2019) new york state office of children and family services child in care medical statement to be completed by licensed physician, physician assistant or nurse practitioner name of child: Web office of children and family services child in care medical statement to be completed by licensed physician, physician assistant or nurse practitioner name of child: / / immunizations required for entry into day care Or call the publications hotline:

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/ / Immunizations Required For Entry Into Day Care

Request for forms and publications to: Immunizations required for entry into day care medical exemption Web this form may be used to meet the consent requirements for the administration of the following: 04/2016) page 3 of 4 is consent of child's parent or guardian for routine medical care on file?

Yes No * A Copy Of The Well Visit Can Be Attached To This Form A Signature Is Required.

Web office of children and family services child in care medical statement to be completed by licensed physician, physician assistant or nurse practitioner name of child: A signature is required on both sides of this form. Or call the publications hotline: / / date of examination:

Ocfs Forms And Publications Unit.

7/2005) front new york state office of children and family services medical statement of child in childcare to be completed by licensed physician, physician’s assistant or nurse practitioner name of child: Only those staff certified to administer medications to day care children are permitted to do so. 06/2019) new york state office of children and family services child in care medical statement to be completed by licensed physician, physician assistant or nurse practitioner name of child: If the only role is a household member, complete ony the front page.

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