For a current health or medical condition requiring child care staff to monitor the condition, provide treatment, care or to give medication, please complete JFS 01236 “Medical/Physical Care Plan.” Please fill out a separate form for each health/medical condition.

If the child’s health/medical condition listed on the “Medical/Physical Care Plan” requires the child care center to administer any of the following: prescription medication, non-prescription medication, a topical product or lotion, a food supplement, or anything else that needs to be administered/given by the child care center, please ALSO complete JFS 01217 “Request for Administration of Medication.”

Preschool Child Medical Statement to be filled out by parent and doctor. Child Medical Statement – JFS 01305