Michigan child care licensing uses this request when it needs a physician's view on whether an applicant, licensee or other person has a physical or mental condition that could affect the care of children. The physician describes the person's general physical and mental health and chooses one of two statements about their ability to provide independent care for children from birth to age 17.
The applicant or licensee fills in the facility or home name and license number, and the patient completes their own details and signs the release of information. The physician completes the medical information section and signs it.
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Medical Clearance Request
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Licensing sends CCL-3704 when it needs a physician's statement about whether a person caring for children, or associated with a child care home, has a physical or mental condition or health problem that could affect the health or safety of children or the quality of their care.
The physician describes the person's general physical and mental condition, then checks either that no condition limits their ability to provide independent care of children from birth to 17, or that a condition would affect that ability, noting any reasonable accommodation in the comments.
The form is issued by Child Care Licensing in the Michigan Department of Lifelong Education, Advancement, and Potential (MiLEAP). It was formerly numbered BCAL-3704 and DHS-OCAL-3704, and previous editions are obsolete.