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Health record Child s physician or clinic Street address OKDHS issued 11-15-2007 07LC038E OCC-38 Page 1 of 2 Does your child have any individual special needs involving routine care behavior and guidance communication or positioning If yes please describe Is your child allergic to any foods medications etc. If yes please describe Describe any special precautions for diet medication or activity if applicable I give permission to the child care staff to consult with health and child development professionals regarding my child s needs. Yes No Transportation I do not give permission for my child to be transported. to nearest medical facility if a medical emergency occurs and I cannot be reached on field trips to and from school Drop-off time Pickup time to and from home Drop-off time other please specify Pick up permission Persons having permission to pick up child I understand this form is supplied by the Oklahoma Department of Human Services OKDHS as a service and that supplying the for....

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How to use or fill out the 07lc046e online

Filling out the 07lc046e form online is essential for providing necessary information about a child's care and needs. This guide will help you navigate each section of the form with clear and supportive instructions.

Follow the steps to complete the 07lc046e form accurately.

  1. Click 'Get Form' button to obtain the form and open it in the editor.
  2. Enter the child's name in the designated field to identify the individual for whom you are providing information.
  3. Select the child's sex using the options provided in the form.
  4. Input the child's date of birth to ensure age-specific needs are addressed.
  5. List the names and relationships of individuals with whom the child resides, as this information is crucial for contact purposes.
  6. Fill in your email address, home street address, area code, state, city, home phone number, and zip code to provide accurate contact and location information.
  7. Provide the mother or guardian's place of employment along with the corresponding phone number for emergency contacts.
  8. Similarly, enter the father or guardian's place of employment and their business, cellular, or page phone number.
  9. List emergency contacts, detailing names and phone numbers in order of preference, in case the parent or guardian cannot be reached.
  10. Attach a copy of the child's immunization record or follow exemption procedures as outlined by the Oklahoma State Department of Health.
  11. Complete the health record section by listing your child's physician or clinic, including their street address, phone number, city, state, and zip code.
  12. Indicate if your child has any special needs or allergies and provide descriptions where necessary.
  13. Answer whether you give permission for child care staff to consult with health professionals regarding your child's needs, marking 'yes' or 'no'.
  14. Decide on transportation permissions, specifying your choices for medical emergencies, field trips, school drop-off and pick-up times.
  15. List the names and phone numbers of persons authorized to pick up your child.
  16. Finally, sign and date the form, noting the date the child entered and withdrew from the facility.
  17. Once all fields are filled out correctly, save your changes, download a copy, print it for your records, or share it as required.

Complete your documents online now to ensure timely processing and accurate information.

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