Here is a sample form you can use to keep your child’s information for caregivers, school, church, etc. The site is not allowing me to format it but at least the headers and typing are available to put into your word processor.
Child’s Information Sheet
Birthdate / Address
Main Contact Number
Current Diagnosis
Allergies
Medications (and how taken – swallowed, chewed, time of day)
Emergency Medication
(and how taken – swallowed, chewed, time of day and when is it an emergency)
Parent(s)
Parent 1 Home: Cell: Address:
Parent 2 Home: Cell: Address:
Private Therapists
Name, Speech, Business Name, Address, Fax Number and Phone Number
Current Doctors
Name, Specialty, Business Name, Address, Fax Number and Phone Number
School Information
Teacher/Therapist, School, class, phone, address, etc.
School/Event Permission
Name, Relationship, Phone Number and Address
Prescriptions filled
Business Name, Address, Fax Number and Phone Number
Insurance Information
Primary: Group # and Member ID# Insurance Name, Address, and Phone Number
Secondary: Group # and Member ID# Insurance Name, Address, and Phone Number
