Get In State Form 49969 2015-2025

Filling out the IN State Form 49969, the health care program for child care centers, is an essential process for ensuring the well-being of children in care facilities. This guide provides a structured approach to help users navigate the form online with ease and confidence.

Follow the steps to complete the form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the child's date of birth in the format of month, day, and year. Ensure that the information is accurate for proper identification.
3. Fill in the child's name in the format of last name followed by the first name. Accurate naming is crucial for record-keeping.
4. Provide the date of admission using the month, day, and year format. This date helps track the child's enrollment status.
5. Complete the address section with the child's residential details. Ensure the number and street, city, state, and ZIP code are entered correctly.
6. Indicate who the child lives with by specifying the relationship (e.g., parent, guardian). This helps in understanding living situations.
7. Enter the contact name and telephone number for emergencies or communication about the child.
8. Proceed to the medical history section. Fill out the communicable disease history, including any conditions present and their dates.
9. Document any allergies or handicapping conditions the child may have. Detail any screenings such as TB risks, developmental screenings, or lead tests, including result dates.
10. In the physical examination section, provide the date of the exam and the child's age. Record findings for various health checks such as skin, eyes, ears, heart, and other areas.
11. Answer the question regarding any health conditions that could be hazardous in a group setting. If 'Yes,' detail the necessary modifications for safe participation.
12. Indicate if any prescriptions or special routines are needed, and elaborate if applicable.
13. Fill in the child’s immunization record, including dates for different immunizations. Ensure to check the appropriate response regarding the child's immunization status.
14. Complete the parent comments section if there is any religious objection to immunizations.
15. Provide the health care provider's signature and date, along with their printed name and title, as required for the form's validation.
16. After reviewing the completed form for accuracy, save your changes, and choose to download, print, or share the form as needed.

Complete your documentation online today for a smoother process!