Form k 905 2403-2025

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4.7 out of 5

22 votes

Form K-905-2403 is a document used to record medical, dental, vision, hearing, and behavioral health appointments for children in the care of the Department of Family and Protective Services (DFPS). It outlines the requirements for completion by caregivers and healthcare providers, detailing necessary information such as appointment reasons, child and caregiver details, visit results, medications, and follow-up actions. The form ensures compliance with licensing standards and policies related to child welfare.

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Click ‘Get Form’ to open it in the editor.
Begin with Section I, where you will enter the child's information including their name, date of birth, and Person Identification Number (PID). Ensure accuracy as this information is crucial for proper documentation.
Next, fill in the caregiver's details. This includes the caregiver’s name, address, phone number, and agency. This section identifies who is responsible for the child during the appointment.
In the 'Reason for Visit' section, select from various options such as medical exams or checkups. Be specific about the reason to ensure appropriate follow-up care.
If medications are involved, indicate whether any are prescribed and provide details like dosage and instructions in the medications section.
Finally, complete Section II if applicable. If a healthcare provider cannot fill it out, ensure that you sign and note that they were unable to complete it.

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Versions	Form popularity	Fillable & printable
2020	4.7 Satisfied (22 Votes)

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