Form 2403-2026

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4.8 out of 5

196 votes

The document is a Medical/Dental/Vision/Hearing Examination Form (Form 2403) from the Texas Department of Family Services and Protective Services, revised in September 2013. It is designed for use by caseworkers and caregivers to document medical examinations for children under the care of the department, detailing necessary information such as child and caregiver details, examination dates, reasons for visits, health care provider information, medications, allergies, and follow-up requirements.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the 'General Information' section. Enter the child's name, date of birth, PID number, and examination date. Ensure all details are printed legibly.
Next, provide caregiver information including their name, phone number, agency, and address. This section is crucial for contact purposes.
In the 'Reason for Visit' section, select the appropriate medical needs from the options provided. Be specific about any illnesses or follow-up visits required.
Complete the 'Medications' and 'Allergies' sections accurately. If there are no allergies or medications, indicate this clearly.
Finally, ensure that the signature of the person filling out this side is included along with the date.

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Versions	Form popularity	Fillable & printable
2013	4.8 Satisfied (196 Votes)

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