ADULT MEDICAL STATEMENT for CHILD CARE 2026

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The document is an Adult Medical Statement required by the Connecticut Office of Early Childhood for individuals applying to work in or operate family child care homes. It includes sections for personal information, medical clearance from a healthcare provider, and assessments regarding any medical or emotional conditions that may affect the individual's ability to care for children. The form aims to ensure the health and safety of children in daycare settings.

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Click ‘Get Form’ to open the ADULT MEDICAL STATEMENT in our editor.
Begin by selecting the appropriate checkbox that corresponds to your role, such as 'Family Child Care Home Applicant' or 'Group Child Care Home Employee'.
Fill in the patient’s personal information, including their name, phone number, date of birth, and address. Ensure accuracy for effective communication.
Instruct a Physician, Physician Assistant, or Advanced Practice Registered Nurse to complete the medical clearance section. They will need to answer whether any medical or emotional issues could pose a risk to children.
Record the date of the most recent examination and ensure that a Tuberculosis check is documented. This is crucial for compliance with child care licensing laws.
Finally, have the medical provider sign and date the form. Their contact information should also be included for verification purposes.

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Versions	Form popularity	Fillable & printable
2022	4.8 Satisfied (48 Votes)
2017	4.4 Satisfied (26 Votes)

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What is a physicians statement of medical necessity?

A Letter of Medical Necessity (LMN) is the written explanation from the treating physician describing the medical need for services, equipment, or supplies to assist the claimant in the treatment, care, or relief of their accepted work-related illness(es).

What is a physicians statement of good health for child care personnel?

Who needs the Physician Statement of Good Health for Child Care? Child care center employees need this form to verify their health status. Parents may need it to ensure child care providers meet health standards. Physicians use this form to document the health qualifications of employees.

What is a health statement for daycare?

A health statement for daycare is a formal document that outlines a childs health status, including any allergies, medications, and specific medical conditions. This statement is essential for daycare providers to ensure that they can meet the individual health needs of each child in their care.

What documents do you need for child care?

What Documents Are Needed for Early Childhood Programs? Proof of Age. One of the first things early childhood programs will ask for is proof of your childs age. Health and Medical Information. Youll also need to submit health and medical documents. Proof of Residency. Legal Custody Documents.

What is a physicians statement of health?

A Statement of Health is a document containing a series of questions about your overall health such as if youre a smoker or if youve ever been treated for a medical condition, like cancer or high blood pressure.

ocfs staff medical form

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What are the health requirements for a child care facility?

Childrens health requirements include physicals, immunizations, and how the program must handle sick children and store and give medication. Program staff health requirements include physicals, tuberculosis testing, drug screening, and required vaccinations.

How do I write a letter for proof of child care?

I am writing to confirm that I am providing childcare for my child, [Childs Full Name], born on [Date of Birth], residing at [Childs Address]. This letter serves as official proof of the childcare arrangements in place.