Epsdt forms pdf 2026

1. Click ‘Get Form’ to open the epsdt form in the editor.
2. Begin by filling in your child's name, date of birth, and sex at the top of the form. This information is crucial for identifying your child.
3. Next, provide your name as the parent or guardian, along with your address and contact details. This ensures that the health care provider can reach you if necessary.
4. Indicate the Pre-K program where your child is enrolled and its phone number. This helps streamline communication between you and the program.
5. In Part I, answer all health-related questions honestly. Check 'Yes' or 'No' for each question regarding your child's health concerns and provide explanations where needed.
6. Sign and date the permission section at the bottom of Part I to authorize sharing this information with relevant parties.
7. Once completed, save your changes and download or share the form directly from our platform for submission to your child's physician.

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