Follow the steps to complete the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the child's name in the designated field at the top of the form. Ensure the name matches official documents to avoid any discrepancies.
3. Next, fill in the date of examination. This date indicates when the medical professional assessed the child's health.
4. Enter the child's date of birth to confirm their age, which is relevant for specific immunization requirements.
5. Move to the section regarding immunizations required for daycare entry. Indicate if a medical exemption applies by checking ‘Yes’ if applicable and attach relevant certification specifying the exempt immunization(s).
6. For each required immunization, input the dates on which the child received them. Include first, second, third, and fourth dates as applicable. Ensure all provided dates are valid and clearly legible.
7. Review additional immunizations that may include vaccines such as Rotavirus, Influenza, and Hepatitis A. Fill in the type of immunization and the corresponding date.
8. Proceed to the tests section. Document the date of the Tuberculin test and results, confirming whether it is positive or negative.
9. Provide lead screening information, including all necessary dates and results, ensuring compliance with New York State law requirements.
10. Complete the health specifics section, marking whether the child has allergies, takes medications, requires a special diet, or has any specific health concerns. Include details as necessary.
11. In the final sections, summarize the physical exam findings and recommendations for daycare providers, ensuring a comprehensive overview of the child's health.
12. Sign the form, including the examiner's title, contact information, and the date. This signature confirms the accuracy and validity of the information provided.
13. After filling out the form, you can save any changes made, download the document for your records, print it out, or share it as needed.

Complete your documents online today for a smooth childcare experience.