LINDA LINGLE GOVERNOR STATE OF HAWAII DEPARTMENT OF

14 AUSTRALIAN ADVOCACY INSTITUTE BELINDA FROST
(A)LINDA LINGLE GOVERNOR INSTRUCTIONS FOR GENERAL APPLICATION CATEGORY I
1 MBIEMRI DACI AJVAZI 2 EMRI MAJLINDA 3 NACIONALITETI

1 RAPPORT ON BEAUFORT EQUIVALENT SCALES RALF LINDAU INSTITUT
12 DEFINICIÓN DE COMPETENCIAS 32507 LINDA ROSA TAMAYO TORO
2008 YILINDA BEYANNAMELERİNİ İMZALATMAK ZORUNDA OLMAYANLAR NOTERLER ÖZEL KANUNLARINA

DHS_LTTR



LINDA LINGLE

GOVERNOR

LINDA LINGLE GOVERNOR STATE OF HAWAII DEPARTMENT OF


STATE OF HAWAII

DEPARTMENT OF HUMAN SERVICES

LILLIAN B. KOLLER, ESQ.

DIRECTOR


HENRY OLIVA

DEPUTY DIRECTOR







TO: Child Care Facility Applicant


FROM:


SUBJECT: INSTRUCTIONS FOR THE MEDICAL REPORT FORM

____________________________________________________________________________


In accordance with Hawaii Administrative Rules (HAR) §§17-892.1, 17-895, 17-896 evidence of a satisfactory physical examination and TB clearance for all required individuals in a licensed child care facility such as a Group Child Care Center (GCC), Group Child Care Home (GCH), Infant & Toddler Child Care Center (IT), or Before & After School Child Care Facility (BAS) shall be kept on file at the facility.


The DHS 984 “Medical Report” form shall be used to comply with the above requirement.


The following information and instructions are provided:


  1. A Medical Report is required for these individuals: Applicants whose duties place them in direct contact with the children or at the actual child care site, employees whose duties include direct care, supervision, and guidance of children in child care or employees whose duties place them in direct contact with the children or at the actual child care center site, volunteers who serve 10 hours or more per week, volunteers who are counted in the staff-child ratio, substitutes, and all adult household members even though not a caregiver in a GCH.


  1. Complete and sign Part I of the Medical Report and have your health care practitioner complete and sign Part II. A health care practitioner is defined as a physician (MD or OD), physician assistant (PA), Advanced Practice Registered Nurse (APRN), or nurse practitioner (NP). Return the Medical Report to the child care facility to keep on file.


  1. The date of the physical examination and date of negative TB test results or satisfactory chest x-ray shall be within one year prior to beginning child care or for adult household members in a GCH, one year prior to the person’s occupancy in the home.


  1. If any individual listed in #1 is no longer conducting child care or whose employment has been terminated, is no longer a household member, or leaves the state for more than 6 months, their Medical Report is no longer valid when applying/reapplying to operate or working another licensed child care facility.



Instructions for the Medical Report Form



  1. If any individual listed in #1 is no longer conducting child care or whose employment has been terminated, is no longer a household member, or leaves the state for less than 6 months and applies/reapplies to operate or work in another licensed child care facility, their Medical Report is still valid unless the employer requires new health clearances.













































DHS 984B (06/09) AN EQUAL OPPORTUNITY AGENCY

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