Maryland's Office of Child Care asks for a medical evaluation of people who work, volunteer or reside in a child care program. The clinician screens for tuberculosis, discusses immunizations and states whether the person is medically and emotionally fit, then marks the age groups they have the strength and mobility to care for.
The person being evaluated (or a guardian, if a minor) fills in their name and program and signs the release to the Office of Child Care. A physician, registered physician assistant or certified registered nurse practitioner completes and signs the evaluation section.
Download the current version from the source each time; forms change without notice.
Medical Evaluation for Child Care
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.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
Not always. The form requires a TB risk and symptom screening, and a TB test only if indicated or required by the Local Health Officer. If a test is done, the clinician records the type, date and result and states whether the person is free of communicable tuberculosis.
The evaluation section must be completed by a physician, registered physician assistant or certified registered nurse practitioner. The signer prints their name and credentials and adds a stamp or complete address and telephone number.
For people working or volunteering in a child care program, the clinician checks the age groups for which the person meets the strength and mobility challenges of caring for a child: 0 to 2, 2 to 6, 7 to 12, or 12 to 18 years.