West Virginia uses this one-page report to show that a person caring for children in a licensed or certified setting is healthy enough to do the job safely. The examiner records medical and mental health history, vital signs, a tuberculosis screen, vision and hearing, medications that could affect child care, and any physical, mental or public health condition that might interfere.
An MD, DO, PA or CRNP examines the provider, completes every section and marks which of the four credentials applies next to the signature. The provider's name and date of birth go at the top.
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Child Care Provider Medical Report
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The ECE-CC-3C states that a Mantoux (PPD) test or chest X-ray is required every two years. The examiner enters the date and result in the Laboratory Tests section, together with vision and hearing results and any other laboratory tests performed.
An MD, DO, PA or CRNP. The signature line asks the examiner to indicate which of the four credentials applies and to enter the exam date. The examiner also prints their name and address at the top of the form.
Physical conditions that could keep the person from typical child care tasks, mental health conditions that could affect a safe and emotionally healthy environment, medications that might affect the ability to care for children, and any medical condition that poses a public health risk. Each has a yes or no answer with space to describe it.