Hawaii's Department of Human Services uses DHS 984 to evaluate whether a child care applicant, employee, substitute, volunteer or household member can care for children or have contact with them in a licensed facility. Part II records TB clearance, any physical disability or mental health history or limitation affecting caregiving, and the examiner's opinion on communicable disease and fitness.
The applicant, employee or household member completes Part I, including facility type, position and an authorization to release the report. A physician, PA, APRN or NP completes and signs Part II.
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Medical Report
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Applicants, employees, substitutes, volunteers and household members in licensed child care settings, including family child care homes, group child care centers and homes, infant and toddler centers, and before and after school facilities. Legally exempt homes are also listed. The report helps DHS evaluate fitness to care for children.
Not necessarily. Part II includes a TB clearance section to complete if other verification of TB clearance is not attached. The examiner checks a negative risk assessment and symptom screen, a negative TB test, or a negative chest X-ray after a positive test, with dates.