F09A - old.lgs.lu 2026

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The document is a medical form for children under 18 years, intended to be filled out by parents. It collects confidential information regarding the child's personal details, medical history, allergies, medications, and emergency contacts. The form also includes sections for parental consent regarding medical treatment in case of emergencies and requires attachments of vaccination and health insurance cards.

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Click ‘Get Form’ to open it in the editor.
Begin by filling in the child's name (Numm) and first name (Virnumm) in the designated fields.
Next, provide the group (Grupp) information. This is essential for categorizing your child appropriately.
Fill out the address section, including street number and name (Adress), postal code (PLZ), and locality (Uertschaft).
Complete the medical history section by detailing any past illnesses, surgeries, or disabilities under 'Medezinesch Virgeschicht'.
List any allergies your child may have in the Allergien section, ensuring to include food, plants, animals, and medications.
Indicate any regular medications your child takes along with their dosage and timing in the relevant fields.
Provide emergency contact details for parents or guardians, ensuring all phone numbers are accurate.
Finally, review all entries for accuracy before signing and dating the form at the bottom.

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