H Childs preadmission record DHR-CDC-739 Revised 2026

1. Click ‘Get Form’ to open the H Child’s preadmission record in the editor.
2. Begin by entering the child's name and the name they are known by in the designated fields. Ensure accuracy for identification purposes.
3. Fill in the child’s birthdate and home address. This information is crucial for emergency contacts and records.
4. Provide details of the parent(s)/guardian(s), including names, home telephone numbers, and addresses. This section ensures that caregivers can reach you when necessary.
5. List employers' information for both parents/guardians, including names, addresses, and contact numbers. This helps in case of emergencies.
6. Complete the emergency contact section by listing individuals who can be reached if you cannot be contacted. Include their relationship to the child.
7. Sign and date the emergency authorization section to grant permission for medical treatment if needed.
8. On page two, describe any special needs or instructions regarding your child. This ensures proper care is provided.
9. Indicate who may pick up your child by filling out their names, relationships, addresses, and phone numbers.
10. Finally, review all sections for completeness before saving or printing your filled form.

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