Get State Form 23923

This guide provides clear and detailed instructions on how to complete the State Form 23923 online. This form is essential for maintaining health records for children enrolled in early childhood development and childcare programs.

Follow the steps to fill out the State Form 23923 effectively.

1. Click ‘Get Form’ button to access the form and open it for editing.
2. Begin by entering the child's name in the designated fields (last name, first name) at the top of the form.
3. Fill in the child's birth date and admission date using the specified format (month/day/year).
4. Provide the child’s street address, city, and zip code in the appropriate fields.
5. Indicate who the child lives with by filling in the name and phone number.
6. Complete the medical history section. Indicate any communicable diseases the child has experienced by checking the relevant boxes and providing details including month and year of occurrence.
7. Note any existing health conditions and physical limitations in the designated sections.
8. Fill out the allergies section, providing specifics as needed.
9. In the physical examination section, record the date of the exam and age of the child. Fill in the health checks for skin, lymph nodes, eyes, ears, nasopharynx, teeth and mouth, heart, lungs, abdomen, genitalia, skeleton, and any other relevant findings.
10. Answer the questions regarding health hazards and medication prescriptions, providing necessary explanations.
11. Complete the history of immunizations, indicating the appropriate dates for all vaccinations listed.
12. Provide the name of the physician completing the form along with their phone number, and ensure the physician signs the form.
13. Finally, review all the entered information for accuracy, then save any changes to your form. You can download, print, or share the completed form as needed.

Ensure all health records are up-to-date by completing the State Form 23923 online today.