JFS 01305 (Rev. 10/202 1) Ohio Department of Job and Family Services CHILD MEDICAL STATEMENT FOR CHILD CARE. Child’s Name (print or type) Date of Birth . Note: Sections A and B must be completed by the examining Health Care Practitioner (Physician/Physician's Assistant/Advanced Practice Registered Nurse/Certified NursePractitioner ):

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I have examined this child and found that he or she is in suitable condition for participation in group care. The child has had the age appropriate immunizations recommended by the Ohio …

CHILD MEDICAL STATEMENT FOR CHILD CARE - storage.snappages.site

JFS 01305 (Rev. 10/2021) Date Signature of Parent Date . Created Date: 6/7/2022 12:29:55 PM ...

JFS 01305 (Rev. 12/2016) Ohio Department of Job and Family Services CHILD MEDICAL STATEMENT FOR CHILD CARE Child’s Name (print or type) Date of Birth This above named child has been examined, the immunization status recorded, and the child is in suitable condition for participation in group care.

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JFS 01305 (Rev. 12/2016) Ohio Department of Job and Family Services CHILD MEDICAL STATEMENT FOR CHILD CARE Child’s Name (print or type) Date of Birth This above named child has been examined, the immunization status recorded, and the child is in suitable condition for participation in group care.

JFS 01305 (Rev. 10/2021) Ohio Department of Job and Family Services CHILD MEDICAL STATEMENT FOR CHILD CARE Child’s Name (print or type) Date of Birth Note: Sections A and B must be completed by the examining Health Care Practitioner (Physician/Physician's Assistant/Advanced Practice Registered Nurse/Certified Nurse Practitioner):

JFS 01305 (Rev. 10/2021) Muskingum University Center for Child Development 740-826-8351 Attn: Sharon Price