Washington's DCYF Licensing Division sends this confidential report when someone applies to become a foster parent or kinship caregiver. The applicant's medical provider describes chronic issues, current diagnoses, medications and prognosis, and says whether any condition could affect caring for children. Licensing uses it as one part of the overall review; DCYF states that no single condition, disability or medication automatically disqualifies an applicant.
The applicant completes Section 1, naming the provider and signing a release, and licensing or child placing agency staff complete Section 2 with the licensor's contact details. The medical provider completes and signs Section 3.
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Applicant Medical Report - Confidential
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The applicant's own medical provider completes Section 3: dates of the most recent physical and first visit, chronic issues, diagnoses, medications, prognosis and any concerns about caring for children. The applicant fills in Section 1 and signs the release, and the licensor or child placing agency fills in Section 2.
Yes. DCYF posts the 13-001 as a Word document in English and in Spanish on its forms page. The Word format lets the provider type the answers before printing and signing, and the licensor's contact details in Section 2 show where the finished report goes.
DCYF says the report is only one part of the overall review and that no single condition, disability or medication automatically disqualifies an applicant. If Licensing has concerns about safe care, it discusses them with the applicant and tries to resolve them before deciding, so specific, functional comments are most useful.