Sample Forms

Sample Parental Notifications

Notification that Facility working with a Child Care Health Consultant

Medication Administration Forms

• Medication Administration Checklist
• Medication Administration Permission and Record
• Medication Administration Permission – topical ointments, etc
• Medication Administration Error Report

Medical Action Plans

• Allergy and Anaphylaxis (non-food)
• Allergy and Anaphylaxis (food)
• Allergy and Anaphylaxis (food) – Español
• Asthma
• Diabetes
• General
• Seizure
• Seizure – Español

Child Health Assessments

• Children’s Medical Report
• Children’s Medical Report – Español

Staff Health Assessments

• Staff Health Assessment/Medical Report
• Tuberculosis Screening or Test Record