Get In State Form 49969 2011

Filling out the IN State Form 49969 is an important step in maintaining the health records of children attending child care centers. This guide provides clear, step-by-step instructions to assist users in accurately completing the form online.

Follow the steps to effectively complete the form:

1. Click ‘Get Form’ button to access the document and open it in your editor.
2. Begin by entering the child's date of birth in the designated field, using the format month, day, year.
3. Fill in the child's name, ensuring to include both the last and first name as specified.
4. Enter the date of admission using the format month, day, year.
5. Provide the full address, including number and street, city, state, and ZIP code.
6. Indicate with whom the child lives, describing the relationship (e.g., parent, guardian) in the field provided.
7. Input the contact telephone number, ensuring accuracy for future communication.
8. Proceed to the medical history section and check the boxes for any communicable diseases that the child may have had, providing additional details if necessary.
9. List any allergies or handicapping conditions the child has in the appropriate fields.
10. In the physical examination section, record the date of the exam and the child's age.
11. Complete the physical assessment by indicating findings from the provided categories (skin, eyes, heart, etc.). Note any unusual findings in the designated area.
12. Answer questions regarding any health conditions that might affect the child's participation in group activities.
13. If applicable, describe any necessary modifications for the child's activities in the context of group settings.
14. Indicate any prescribed medications or special routines that need to be included in the child's activity plan.
15. Fill out the history of immunizations and tests by recording the relevant dates in the designated fields.
16. Lastly, ensure the form is completed by providing the name and contact number of the physician or nurse practitioner, along with their signature.
17. Once all sections are filled out, save the changes, download the form, or print it for submission.

Complete your health care program documentation online today.