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Minnesota MS-2083 Health Care Summary (Child Care)

Minnesota licensed child care centers ask families for a summary of the child's health from the child's health care source at enrollment. This one-page form, headed 'Must be completed by health care source', tells the center about allergies, diet, conditions that could lead to an emergency, vision, hearing and speech, and any health problems that need attention at the center.

Who completes it

The child's health care source, such as a physician, nurse practitioner, physician assistant or public health clinic, completes the whole form and signs it. Parents do not complete a section.

Submitting and payment

How to submit it
The completed summary is returned to the parent, who gives it to the child care center at enrollment.
Who pays
The form sets no fee and does not address payment for completing it.

Good to know

  • The provider records the date of the last physical exam, how long they have seen the child and how often they see the child when not ill.
  • A health problems table asks whether each problem is followed by the provider or another medical source, named, and whether it requires special attention at the center.
  • Short questions cover allergies including medication allergies, whether a modified diet is necessary and whether any condition might result in an emergency.
  • The summary supports the enrollment health requirement in Minn. R. 9503.0070; center licensing has since moved from DHS to the Department of Children, Youth, and Families.

Get the official form

Download the current version from the source each time; forms change without notice.

Health Care Summary

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Who fills out the Minnesota Health Care Summary?

The form is headed 'Must be completed by health care source,' so the child's physician, nurse practitioner, physician assistant or clinic completes it and signs as the health source, adding phone, address and date.

What does a child care center learn from form MS-2083?

The center learns the date of the last exam, allergies, diet needs, conditions that might cause an emergency, the status of vision, hearing and speech, important health problems and who follows them, and other information helpful to the program.

Does the Minnesota Health Care Summary ask about vision and hearing?

Yes. The provider writes the status of the child's vision, hearing and speech, then lists important health problems, noting whether each is followed by them or by another named medical source and whether it requires special attention at the center.