Get Demographic Information Sheet

The Demographic Information Sheet is a crucial document that collects important data regarding a child and their family. This guide will provide you with step-by-step instructions on how to complete this form online efficiently and accurately.

Follow the steps to complete the Demographic Information Sheet online

1. Click the 'Get Form' button to access the Demographic Information Sheet and open it for editing.
2. Begin by filling out today's date in the designated field. This ensures that all information is recorded accurately with respect to the time it is provided.
3. Enter the child's full name, including first, middle, and last names, in the provided space.
4. Complete the child's date of birth using the format MM/DD/YYYY, making sure to input the month, day, and year correctly.
5. If the child was born premature, indicate the number of weeks premature in the specified section.
6. Select the child's gender by marking the appropriate option for male or female.
7. Fill in the child's race and ethnicity in the corresponding field.
8. Provide the child's birth weight in pounds and ounces.
9. Enter the name of the parent or primary caregiver, making sure to include first, middle, and last names.
10. Describe the relationship of the parent or primary caregiver to the child in the allocated space.
11. Complete the street address, city, state or province, and ZIP or postal code of the child's residence.
12. Input the home telephone number, work telephone number, and any cell or other telephone numbers in the designated fields.
13. Provide an email address for communication purposes.
14. List the child's primary language and any additional languages spoken in the home.
15. Fill in the child's primary care physician's information, including their name and the clinic or practice name.
16. Provide the mailing address for the clinic, including city, state or province, and ZIP or postal code.
17. Enter the telephone number of the clinic and the fax number if available.
18. List any medical conditions that the child has in the provided space.
19. Mention any other agencies that are involved with the child or family in the allocated section.
20. Complete the program information section, including the child ID, date of admission to the program, adjusted age if applicable, program ID, and program name.
21. Once all sections are accurately filled out, review the form for any errors or missing information prior to submission.
22. Finally, save your changes, and if needed, download, print, or share the completed form.

Begin filling out the Demographic Information Sheet online today for efficient document management.