WebHow to Download Child Health Record Forms. Go to the Texas Health Steps online catalog and click on the Browse button. Under Main Menu, click on View Catalog Items, then … Webhealth examination for a child not fully immunized for religious reasons. Sections 1b and 1c. Health Examination Documentation (if required): Requirements set by local educational authorities. If necessary, provide date of examination and signature/stamp of the certifying healthcare provider. Also, check if dental or vision screening is needed.
Certificate of Child Health Examination (En Español) - Illinois
WebThe examination must be reported on the Illinois DHS-Certificate of Child Health Examination form & include a complete immunization record and medical history. … WebRevised 4-25-13 SHP 4 12. Who can sign the Immunization History portion of the “Certificate of Child Health Examination” form? RESPONSE: The immunization history portion of the form can be signed by a physician, nurse in physician’s office, school nurse, record keeper in schools, local health agency, etc. buster merryweather
DHS State Of Illinois Certificate Of Child Health Examination Form
WebDEPARTMENT OF HUMAN SERVICES CERTIFICATE OF CHILD HEALTH EXAMINATION Grade Level /ID# Work Middle ZIP code Birth Date Month/D / Year Parent/ Guardian Sex School Telephone Home IMMUNIZATIONS: To be completed by health care provider. Note the mo/da/yr for every dose administered. The day and month is required … WebCertificate of Child Health Examination. FOR USE IN DCFS LICENSED CHILD CARE FACILITIES. CFS 600 . Rev 12/2011 . Student’s Name. Last First Middle Birth Date. Month/Day/Year . Sex Race/Ethnicity School /Grade Level/ID# Address Street City Zip Code. Parent/Guardian Telephone # Home Work . WebOnly the State of Illinois Department of Human Services Certificate of Child Health Examination form will be accepted. ... Students entering school for the 1st time (kindergarten or transfer) must submit evidence of a vision exam. All required health forms are available at the school office or by clicking on the attached links. The school nurse ... buster merryfield without beard