Get Child Information Record State Of Michigan Department Of Human ...

Completing the Child Information Record for the State of Michigan Department of Human Services is an essential step in ensuring that your child's information is accurate and accessible. This guide will provide you with clear, step-by-step instructions to help you through the process of filling out the form online.

Follow the steps to complete the Child Information Record effectively.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred browser or editor.
2. Enter the name of the child in the format of last name, first name, and middle initial. Follow this by providing the child's date of birth.
3. Fill in the child’s residential address, including the street number, building or apartment number, city, state, and zip code.
4. Provide the child’s home phone number with the appropriate area code.
5. In the next section, enter the names and home phone numbers of both parents or legal guardians. Be sure to include a cell phone number for each if available.
6. If the parents’ or guardians’ home addresses differ from the child’s address, include these addresses in the provided fields.
7. List the employer or school name for each parent or guardian, along with the address and phone number. Additionally, provide daily work or school times.
8. Indicate any individuals, other than parents or legal guardians, who may be authorized to release the child.
9. Complete the section granting permission for medical treatment by providing the licensed provider's name, parent or guardian's signature, and date signed.
10. Add the name of the child's physician or health clinic, including the contact phone number and address.
11. Enter the name of the health insurance carrier and the policy number. Also, specify the hospital preferred for emergency treatment.
12. If applicable, note any special needs for the child, as well as the date of the last DTaP shot.
13. Provide the name and contact information of a local person to notify in an emergency when the parents are unavailable.
14. Include any special instructions that might be pertinent for the care of the child.
15. Once all sections have been completed, review the form for accuracy. Users can then choose to save changes, download, print, or share the completed form.

Start filling out your Child Information Record online today to ensure your child's details are correctly submitted.