"Health Statement" - Nevada

Health Statement is a legal document that was released by the Nevada Department of Health and Human Services - a government authority operating within Nevada.

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HEALTH STATEMENT
CHILD'S NAME:
BIRTH DATE:
PARENT'S NAME:
PARENT'S ADDRESS:
STATUS OF THE ABOVE CHILD'S HEALTH
ANY KNOWN CONDITIONS UNDER TREATMENT
CHILD IS CAPABLE OF ADJUSTING TO PROGRAMS OF THE CHILD CARE FACILITY
YES/NO - REASON
SIGNED
DATE
(M.D. or R.N.)
HEALTH STATEMENT
CHILD'S NAME:
BIRTH DATE:
PARENT'S NAME:
PARENT'S ADDRESS:
STATUS OF THE ABOVE CHILD'S HEALTH
ANY KNOWN CONDITIONS UNDER TREATMENT
CHILD IS CAPABLE OF ADJUSTING TO PROGRAMS OF THE CHILD CARE FACILITY
YES/NO - REASON
SIGNED
DATE
(M.D. or R.N.)
HEALTH STATEMENT
CHILD'S NAME:
BIRTH DATE:
PARENT'S NAME:
PARENT'S ADDRESS:
STATUS OF THE ABOVE CHILD'S HEALTH
ANY KNOWN CONDITIONS UNDER TREATMENT
CHILD IS CAPABLE OF ADJUSTING TO PROGRAMS OF THE CHILD CARE FACILITY
YES/NO - REASON
SIGNED
DATE
(M.D. or R.N.)
HEALTH STATEMENT
CHILD'S NAME:
BIRTH DATE:
PARENT'S NAME:
PARENT'S ADDRESS:
STATUS OF THE ABOVE CHILD'S HEALTH
ANY KNOWN CONDITIONS UNDER TREATMENT
CHILD IS CAPABLE OF ADJUSTING TO PROGRAMS OF THE CHILD CARE FACILITY
YES/NO - REASON
SIGNED
DATE
(M.D. or R.N.)