Get Documentation Of History Of Varicella Chickenpox Disease Documentation Of History Of Varicella

Filling out the DOCUMENTATION OF HISTORY OF VARICELLA CHICKENPOX DISEASE form is an important step for parents or guardians of children attending daycare. This guide will provide clear and supportive instructions to ensure that you complete the form accurately and efficiently.

Follow the steps to complete the documentation process.

1. To begin, click the ‘Get Form’ button to access the form. This will allow you to open it in your preferred document editor.
2. In the first field, enter the full name of the child for whom you are completing this documentation. Ensure accuracy as this identifies the individual in relation to the daycare's records.
3. Next, input the child's date of birth in the designated field. This information helps verify the child's age at the time of the illness.
4. In the following area, affirm that your child has had varicella (chickenpox) disease prior to the necessary age for immunization. This declaration is crucial for daycare requirements.
5. Provide the specific date when the illness occurred. This detail is important in confirming the history of the disease.
6. The form requires signatures from the parent or guardian. Ensure that you sign and date the form accurately in the provided spaces.
7. If applicable, a second parent or guardian may also sign and date the form in their respective spaces.
8. A signature from a member of the daycare staff is required to acknowledge receipt of this documentation. Ensure the staff member signs and dates the form.
9. Lastly, fill in the name and address of the daycare in the space provided. This ensures the form is linked to the correct institution.
10. After completing all the fields, review the document for accuracy. You can then save changes, download, print, or share the form as necessary.

Complete the DOCUMENTATION OF HISTORY OF VARICELLA CHICKENPOX DISEASE form online today!