Follow the steps to complete the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the child’s name in the designated format: last name, first name. Then, provide the birthdate in the specified field.
3. Fill in the street address, city, and zip code of the residence where the child lives.
4. Indicate who the child lives with, including their name and phone number.
5. For the medical history section, check and note any communicable diseases the child has had, indicating the month and year. Provide details about allergies and any handicapping conditions.
6. In the physical examination section, fill the date of the exam, and specify the child’s age. Assess and make notes on the various health categories listed, including skin, heart, lymph nodes, lungs, and more, detailing any unusual findings.
7. Indicate if there are any prescribed medications or special routines necessary for the child's activities at the center. If applicable, describe these requirements.
8. Complete the history of immunizations by indicating the month, day, and year for each vaccination. Ensure that all required immunizations are noted, including DTP, IPV, Measles, and others.
9. Print the name and telephone number of the physician completing the form, and ensure the physician's signature and date are provided.
10. After reviewing all entries for accuracy, save changes to the form. You may then choose to download, print, or share the completed form as necessary.

Complete your child's health record online to ensure accurate and timely documentation of their health status.