Connecticut requires complete primary immunizations and a health assessment before a child enters an early childhood program, such as a licensed child care center, group child care home or preschool. ED 191 is that assessment record for children from birth to age 5. It covers health history, a medical evaluation with screenings, an oral health assessment and the immunization record.
The parent completes Part 1, the health history. A physician, APRN or PA completes and signs Part 2 and the immunization record; Part 3, the oral health assessment, is signed by a dentist, dental hygienist or trained MD, DO, APRN or PA.
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Early Childhood Health Assessment Record (For children ages birth-5)
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ED 191 is for children from birth to age 5 entering a child care center, group child care home or preschool. HAR-3 is the school-age Health Assessment Record used before public school entry and in later grades. Both have parent, medical, oral health and immunization parts.
Yes. If the provider marks asthma, the form asks for a copy of an Asthma Action Plan and whether rescue medication is needed in child care. For a history or risk of anaphylaxis, it asks for an Emergency Allergy Plan and whether an EpiPen is required.