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Click ‘Get Form’ to open the medical report in the editor.
Begin by filling in Section A with the name and date of birth of the person evaluated. Ensure accuracy as this information is crucial for identification.
In Section C, provide the name and address of the child care applicant or facility. This helps link the evaluation to the appropriate provider.
For Section D, select the reason for examination by checking one of the boxes: Initial Employment, Biennial Update, or Other.
Section E outlines various child care activities. Review these carefully to ensure that all relevant activities are assessed during the medical evaluation.
Sections F and G require input from a qualified health care provider. Ensure they complete all necessary evaluations and provide their signature and credentials.

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