North Carolina licensed child care centers and family child care homes ask for this medical report when a child enrolls. The parent may complete the history, and the examiner records a head-to-toe physical, growth percentiles, any tuberculin test, a developmental evaluation and whether activities should be limited, so caregivers know about allergies, medications and special care.
The parent may complete Part A, the medical history, and signs it. Part B must be completed and signed by a licensed physician, an authorized agent approved by the N.C. Board of Medical Examiners or a bordering state's board, a certified nurse practitioner, or a qualified public health nurse.
Download the current version from the source each time; forms change without notice.
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Part B must be signed by a licensed physician, the physician's authorized agent currently approved by the N.C. Board of Medical Examiners or a comparable board in a bordering state, a certified nurse practitioner, or a public health nurse meeting DHHS standards for the EPSDT program.
Yes. The Division of Child Development and Early Education posts a Spanish version of the Children's Medical Report next to the English form on its provider documents and forms page.
The form records the results of a tuberculin test only if one was given: type, date, normal or abnormal, and follow-up. It does not itself require testing for every child.