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The Medical Clearance Request for Child Care Licensing is a mandatory form used in Michigan to evaluate the physical and mental health of individuals applying to work as child caregivers. The primary goal is to ensure that caregivers are medically fit to provide a safe and healthy environment for children under their care. The form includes sections for documenting applicant information, detailing the medical history of the applicant, and acquiring a professional evaluation from a licensed physician.
This form serves as a critical tool in safeguarding the well-being of children by preventing individuals with certain health conditions from being employed in child care settings where they might pose a risk to children’s health and safety.
To effectively use the Medical Clearance Request form, applicants must fill out multiple sections accurately. Follow these steps:
Applicant Information: Provide your full name, address, and contact information. This ensures that the submitted form can be easily linked to you.
Authorization for Medical Release: Sign the consent for your physician to release your medical information necessary for the evaluation process on the form.
Physician’s Evaluation: Schedule an appointment with your physician and bring the form. Make sure your doctor fills out the evaluation section, detailing any medical conditions and their implications on your ability to care for children.
Submission: Once the form is completed by your physician, you may need to submit it to the appropriate state department for review as part of your child care licensing application.
Completing the Medical Clearance Request accurately is crucial. Here is a step-by-step guide:
Collect Necessary Documentation: Before filling out the form, gather all required documentation, such as your ID, proof of residence, and any previous medical records that may be pertinent.
Fill Out Applicant Sections: Carefully fill in your personal information, ensuring all details match your official records.
Complete Medical History: Document any known medical conditions or treatments that could impact your capability to oversee children.
Obtain Physician Evaluation:
Review and Proofread: Double-check all information for accuracy and completeness, asking your physician to verify the medical sections again.
Submit to Licensing Authority: Send the completed form and any additional documents to the relevant child care licensing department for processing.
Several essential components make up the Medical Clearance Request form:
Understanding specific terms is crucial for properly engaging with the Medical Clearance Request:
Eligibility criteria for completing the Medical Clearance Request are specific:


Though focused on Michigan, similar rules might apply to other states. However, always verify:
When submitting the Medical Clearance Request form, ensure you include the following:
This comprehensive coverage aims to provide applicants with the necessary understanding and tools to effectively navigate the Medical Clearance Request process for child care licensing, thus promoting the safety and health of children under care.
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○A detailed letter of medical necessity (LMN) that includes: 1. A comprehensive history and physical exam by a licensed physician, physical therapist or
All child care facilities must meet minimum health, safety, and program standards set by. Maryland law. To remain licensed, facilities must maintain compliance