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Get Individual Health Care Plan Form

Titioner __ Program’s Health Care Consultant __ Older school age child (9+ yrs. of age) __ Other: __________________________ Plan is maintained by: __ Director __ Assistant Director __ Child’s Educator __ Other: ___________________________ Name of child: Date: Any change to the child’s Health Care Plan? YES (indicate changes below) Name of chronic health care condition: NO (updated physician/parental signatures required) Description of chronic health care condition: Symptoms: Medic.

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