ADULT MEDICAL STATEMENT for CHILD CARE 2026

1. Click ‘Get Form’ to open the ADULT MEDICAL STATEMENT in our editor.
2. Begin by selecting the appropriate checkbox that corresponds to your role, such as 'Family Child Care Home Applicant' or 'Group Child Care Home Employee'.
3. Fill in the patient’s personal information, including their name, phone number, date of birth, and address. Ensure accuracy for effective communication.
4. 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.
5. 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.
6. Finally, have the medical provider sign and date the form. Their contact information should also be included for verification purposes.

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