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Emergency Care

PDF: Health History and Emergency Care Plan, CFS-2345

Download 14 times Source: www.uwsp.edu // Topic: Emergency Care File Size: 32.39 kb // Total of Page: 2 Page(s) Last download by MORENA Last download on: 3 months ago Share this info: Sample of page (click to enlarge) Short Desciption: HEALTH HISTORY AND EMERGENCY CARE PLAN. Use of form: This form is required for family and group child care centers to comply with HFS 45.04(6)(a)1., ... Content Inside: DEPARTMENT OF HEALTH AND FAMILY SERVICES Division of Children and Family Services CFS-2345 (Rev. 07/2005) STATE OF WISCONSIN HEALTH HISTORY AND EMERGENCY CARE PLAN Use of form: This form is required for family and group child care centers to comply with HFS 45.04(6)(a)1., 45.07(6)(L)5., 46.07(6)(k)5., and 46.04(6)(a)6. of the Wisconsin Administrative Codes. Failure to comply may result in issuance of a noncompliance statement. This form may also be used by day camps to ensure compliance with HFS 55.44(6)(g). Personally identifiable information gathered on this form will be used only to verify compliance with licensing rules. Instructions: The parent / guardian should complete this form for placement in the childs file prior to the childs first day of attendance. A periodic review by parents / guardians and staff is recommended. Information contained on the form shall be shared with any person caring for the child. CHILD INFORMATION Name (Last, First, MI) Telephone Number PARENT /