Missouri child care facilities keep this medical examination report on file for each caregiver and staff member, ready for review during inspections. The examiner certifies the person is in good physical and emotional health and free of contagious disease, documents tuberculosis clearance, and notes any limitations or restrictions, such as being unable to lift heavier children.
The patient completes the identifying information, including the child care facility where they work. A licensed physician, advanced practice nurse, registered professional nurse, or registered nurse supervised by a licensed physician completes and signs the medical report.
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Medical Examination Report for Caregivers and Staff
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The examiner checks one of three options: a TB Risk Assessment form attached (Missouri's form is MO-580-3015), a negative tuberculin skin test attached, or a chest X-ray or written follow-up of a previous examination showing the person is free of contagion, with its date.
The medical report section may be completed by a licensed physician, an advanced practice nurse, a registered professional nurse, or a registered nurse working under a licensed physician's supervision. A supervised nurse must also list the physician's name.
No. The instructions say the completed form should be kept on file at the child care facility for review during inspections. DESE lists it among sample forms that are kept at the facility rather than submitted to the Office of Childhood.