Get Nebraska Divisision Of Public Health Licensure Unit Children's Services Licensing Program Health

Completing the Nebraska Division Of Public Health Licensure Unit Children's Services Licensing Program Health form is essential for ensuring the health and safety of individuals caring for children. This guide will provide you with step-by-step instructions to help you fill out the form accurately and efficiently.

Follow the steps to complete the health information report online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Section A must be completed by the applicant or provider. Fill in your name, birth date, street address, city, state, zip code, and telephone number in the designated fields. If you work at a facility, include the facility’s name and address.
3. List all prescription medications you are currently taking. If you are not taking any prescription medications, specifically state ‘NONE’.
4. Provide your signature in the designated area as the applicant/provider, and include the date of signing.
5. Section B is to be completed by a health professional. They should record your blood pressure reading and results from a urinalysis, specifically noting albumin and sugar levels.
6. The health professional must indicate if you have been treated for substance abuse, alcohol dependency, hypertension, a communicable disease, mental illness, or any other condition affecting your ability to care for children. Provide dates for any affirmative responses.
7. If all health checks show 'No' and you are not on medication, a Registered Nurse may sign to verify your health status without conditions affecting childcare capabilities.
8. If there are any affirmative responses or if you are on medication, a Physician, Physician Assistant, or Nurse Practitioner must assess your condition and provide a signed explanation regarding its impact on caring for children.
9. The health professional must include their signature, license number, printed name, date, telephone number, street address, city, state, and zip code.
10. After completing all sections, save changes to the document, and ensure to download, print, or share the form as required.

Complete your health information report online today to ensure timely processing of your application.