Texas child care minimum standards require infants to sleep on their backs in a crib, never in restrictive devices or swaddled. When a health care professional decides it is medically necessary for an infant to sleep in another position, in a device such as a bouncer seat or swing, or swaddled, this form documents the exception so the child care operation can follow it.
The parent completes the infant's information and signs the waiver of liability. The infant's health care professional describes the medical condition, the sleep position, device or swaddling technique and effective dates, and signs; an official of the child care operation signs last.
Download the current version from the source each time; forms change without notice.
Infant Sleep Exception/Health Care Professional Recommendation
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Form 3019 can allow an alternative sleep position other than on the back, sleep in a restrictive device such as a bouncer seat or swing, or swaddling for sleep, when the infant's health care professional determines it is medically necessary and describes how to do it.
It is an interactive Adobe form. Browser PDF viewers may show only a 'Please wait' message, and HHSC notes that some of its forms must be opened in the desktop Adobe Reader application instead of a browser viewer.
Yes. HHSC lists Form 3019, Infant Sleep Exception/Health Care Professional Recommendation, in English and Spanish on its child day care regulation forms page, along with the related Form 2550, Operational Policy on Infant Safe Sleep.