Dss form 2901-2025

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The document is a Medical Statement form from the South Carolina Department of Social Services, intended for staff, volunteers, and emergency personnel. It collects personal health information, including medical history and current health status, to ensure the safety and well-being of individuals involved in child care regulatory services.

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Click ‘Get Form’ to open the dss form 2901 in the editor.
Begin by entering your name, Social Security Number (SSN), and home address in the designated fields. Ensure accuracy for proper identification.
Select your gender and input your date of birth. This information is crucial for health assessments.
Provide a brief statement regarding your present health in the provided text box. Be honest and thorough to ensure accurate evaluations.
For each listed illness or condition, check 'Yes' or 'No' as applicable. If you answer 'Yes' to any, be prepared to provide further explanations in the space provided.
Complete the section regarding tuberculosis (TB) by entering the date of verification from a physician if you are a new employee, or check if additional tests are required for current employees.
Finally, certify that all information is true by signing and dating the form at the bottom.

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Versions	Form popularity	Fillable & printable
2007	4.9 Satisfied (56 Votes)

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