Transcription of HEALTH CARE PLAN FOR DAYCARE - Educational Playcare
1 HEALTH care plan FOR DAYCARE An individual plan of care is required for any child with special HEALTH care needs or disabilities as described in Section 19a-79 of the Connecticut General Statutes and Section 19a-79-5a of the Connecticut Regulations for Licensing Child Day care Centers and Group Day care Homes. Child s Name DOB HEALTH Condition(s) Signs and Symptoms DAYCARE Staff May Witness Circumstances Which Require Staff Attention or Medication and the plan of Action Circumstances Which Require Immediate Emergency care (911) and the plan of Action Medications To Be Administered at DAYCARE and Specific Instructions for Use Note: This does not replace the requisite Authorization for the Administration of Medication form. Other Treatment(s) or Accommodation(s) Required at DAYCARE Medication(s) Taken at Home (optional) Preferred Hospital Medical Provider Name/Address/Phone/Fax Medical Provider Signature Date Parent or Guardian Name/Address/Phone Parent or Guardian Signature Date FOR DAYCARE CENTER USE ONLY Director s Signature Date HEALTH Consultant s Signature Date Medical Navigators LLC All Rights Reserved Sep 11
