Alabama DHR-FCS-623 Child's Medical Record, Foster Care

Alabama DHR uses this two-page record for children in foster care and in licensed child care or residential facilities. The examining physician documents a full physical, immunizations, routine tests and past illnesses, then certifies whether the child is free of contagious and infectious disease. The second page logs routine re-examinations, so the same form follows the child in the facility's record.

Who completes it

The examining physician completes the form, from the identifying details and exam through the certification, and signs each routine re-examination on the second page.

Submitting and payment

How to submit it
The completed form stays with the agency or facility in the child's record, and later re-examinations are added to the same form.
Who pays
The form sets no fee and does not say who pays for the examination.

Good to know

  • The physician checks one of two statements: the child is free of contagious and infectious disease, or is not, with an explanation on the reverse side.
  • Immunization rows reflect the March 2000 edition: DTaP or DT, polio, MMR (2 doses), Hib (4 doses), hepatitis B (3 doses), chickenpox and other immunizations.
  • Urinalysis, hemoglobin and a TB skin test have date and result fields; neurological and stool exams are marked as needed only if indicated.
  • Adults in the same foster homes and facilities use the separate DHR-2092 Medical Report.

Get the official form

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

Child's Medical Record - Foster Care

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.

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 signs Alabama's Child's Medical Record for foster care?

The examining physician. They date the exam, check whether the child is or is not free of contagious and infectious disease, and sign. Later routine re-examinations are dated and signed by the examining doctor in the boxes on the second page, which also has space for the physician's comments.

Where is the DHR-FCS-623 kept?

With the agency or facility, in the child's record. It is posted among the forms on Alabama DHR's Office of Residential Licensing page for child placing agencies, and its second page is designed to record routine re-examinations over time.