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Get Ca Pm 171 A 2001

State of California Health and Human Services Agency Primary Care and Family Health Division Department of Health Services Children s Medical Services Branch Child Health and Disability Prevention CHDP Program REPORT OF HEALTH EXAMINATION FOR SCHOOL ENTRY To protect the health of children California law requires a health examination on school entry. Please have this report filled out by a health examiner and return it to the school* The school will keep and maintain it as confidential information* PART I TO BE FILLED OUT BY A PARENT OR GUARDIAN CHILD S NAME Last First ADDRESS Number/Street City Middle BIRTHDATE Month/Day/Year ZIP Code SCHOOL HEALTH EXAMINATION IMMUNIZATION RECORD NOTE All tests and evaluations except the blood lead test must be done after the child is 4 years and 3 months of age. Note to Examiner Please give the family a completed or updated yellow California Immunization Record. Note to School Please record immunization dates on the blue California School Immunization....

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How to fill out the CA PM 171 A online

The CA PM 171 A form is essential for ensuring that children receive the necessary health examination before entering school. This guide provides clear, step-by-step instructions on how to complete the form online, ensuring that users can easily navigate through each section.

Follow the steps to complete the CA PM 171 A online.

  1. Click the ‘Get Form’ button to access the online version of the CA PM 171 A form and open it for editing.
  2. In Part I, enter the child's legal name by filling in the last name, first name, and middle name where indicated. Provide the full address, including the number, street, city, and ZIP code.
  3. Still in Part I, fill in the child's birthdate using the format of month, day, and year. Be sure to select the correct school that the child will be attending.
  4. In Part II, the health examiner will complete several sections including the health examination results and immunization record. Ensure that the examiner details all required tests and evaluations conducted for the child.
  5. Provide the dates when each vaccination dose was administered in Part III. This includes filling out the dates for vaccines such as polio, DTaP, MMR, and others listed.
  6. After all necessary fields are filled out, review the additional information section from the health examiner if available. Check the box if the health examiner should not fill out Part III.
  7. Both the parent or guardian and the health examiner must sign the form where indicated, noting the date of signature. Ensure that the examiner also includes their contact information.
  8. Once you have completed all sections of the form, review it for accuracy. You may then choose to save changes, download, print, or share the completed form as required.

Complete the CA PM 171 A online to ensure your child's health examination is recorded properly for school entry.

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GC-210 CA is the form used to request a court order for the appointment of a guardian in California. This form is essential for anyone looking to establish guardianship for a minor. By completing the GC-210 CA, you initiate the process within the legal system, ensuring the minor receives the necessary protection and care. For additional support, USLegal can guide you through the completion of this form.

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© Copyright 1997-2026
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Your Privacy Choices
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
altaFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2026
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
CA PM 171 A
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