Medical Form For Daycare - Medical record for all children in child care facilities, including provider’s own children. If this individual is employed in a child care facility that cares for children age 6 and under, please check two of the following:. Tb tests are at the physician’s discretion. If the child has not been tested for lead, the day care provider may not exclude the child from child day care, but must give the parent information. Child medical statement for child care. Child’s name (print or type) date of birth. This above named child has been examined, the. Parents are to complete the medical.
Parents are to complete the medical. If this individual is employed in a child care facility that cares for children age 6 and under, please check two of the following:. Tb tests are at the physician’s discretion. Medical record for all children in child care facilities, including provider’s own children. Child medical statement for child care. This above named child has been examined, the. If the child has not been tested for lead, the day care provider may not exclude the child from child day care, but must give the parent information. Child’s name (print or type) date of birth.