Child’s Medical Statement

We are required to have a current medical form on file for your child.

A JFS 01305 Child’s Medical Statement is:

  • Required for ages 6 weeks through RiverTree Kindergarten
  • Must be submitted no later than 14 days after the child’s admission and be updated annually

DOWNLOAD THE REVISED MEDICAL FORM HERE

OAC 5101:2-12-37 requires form JFS 01305 Child’s Medical Statement For Childcare Centers to be signed by your child’s examining physician for your child’s file.

The form is only considered “current” for 13 months from the date of exam written in on the form by the pediatrician.

It must be updated annually and turned into the school office before the examination date expires.

OAC 5101:2-12-37 Children’s medical records for licensed child care centers states:

(A) Each child attending the licensed child care center, including those children who are attending kindergarten at the center, shall secure and have on file verification of a medical examination. Children who attend a grade of kindergarten and above in an elementary school are exempt from this requirement.

(1) A medical statement shall verify the date of a medical examination within the past twelve months. This statement shall be on file at the center within 14 days of the child’s date of admission and every thirteen months thereafter.

(2) The medical statement shall contain the following information:

(a) The child’s name and birth date.

(b) The date of the medical examination.

(c) A statement that the child has been examined and is in suitable condition for participation in group care.

(d) The signature, business address and telephone number of the physician, physician’s assistant (PA), advanced practice nurse (APN) or certified nurse practitioner (CNP) who examined the child.

(e) A record of the immunizations that the child has had, specifying the month, day and year of each immunization.

(f) A statement that the physician, PA, APN, or CNP reviewed the child’s record against the immunizations recommended by the Ohio department of health (ODH).

(g) A statement of any immunization exemptions.

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7373 PORTAGE ST NW, MASSILLON OH 44646   330.494.1860
SERVING JACKSON TOWNSHIP, MASSILLON, CANTON. CANAL FULTON. NORTH CANTON. GREEN. CLINTON, UNIONTOWN AND SURROUNDING AREAS