WebComm. 143 (Rev. 12/21) Page 81 Recommendations for Preventive Pediatric Health Care – Infant, Toddler, and Preschool Age Bright Futures/American Academy of Pediatrics Each … Web(NAME OF CHILD CARE CENTER/SCHOOL) . This Child Care Center/School provides a program which extends from : a.m./p.m. to a.m./p.m. , days a week. Please provide a report on above-named child using the form below. I hereby authorize release of medical information contained in this report to the above-named Child Care Center.

PHYSICIAN

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Child Enrollment and Health History - Certified Child Care, …

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