Child's Health File Checklist

San Francisco Department of Public Health Child Care Health Program

CHILD’S HEALTH FILE CHECKLIST *

CHILD’S NAME: ______________________________________________

Required Documents                                    Year:

Comments

Emergency Info (LIC 700)

Pre-admission Health History Parents’ Report (LIC 702)

Medical Assessment including TB Risk Evaluation (LIC 701)

Medical Care Plans and Medication Forms 

Consent for Medical Treatment (LIC 627) or Waiver

Immunization Record

Pre-Service Plans (infant, feeding, toileting, special needs))

Individual Sleeping Plan (LIC 9227)

Sunscreen Permission Form

Mid-Day Toothbrushing Permission Form

CCHP Health Screening Consent

CCHP Health Screening Results

Copy Provided to Parents:

Admission Agreement 

Daily Health Check Policy

Medication Policies 

Illness Policy Exclusion Guidelines

Discipline Policy

Environmental Hazards Notice

Resource & Referral List

Safe Sleep Pamphlet

Medication Policies

Lead Poisoning Prevention Flyer

Immunization Requirements

Notification of Parent’s Rights (LIC 995)

Personal Rights (LIC 613A)

*Please refer to licensing for updated requirements: LIC 311A and LIC 311D were updated in 2022*