Physician's Recommendation Form

CDC Health Policy:

For readmission into the Child Development Center,

your child must be symptom and fever free for at least

24 hours, unless they are seen by a physician.  The physician

will need to give their recommendation for readmission by

completing and signing this form.  In order for your child

to be readmitted, this form must be returned to the

Child Development Center and your child must be able

to participate in normal daily activities.

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Child's Name:________________________________________ 

Date of Physician's visit: _________________________________

Diagnosis: ___________________________________________

Treatment: __________________________________________

Date this child may be admitted back into the Child Development Center:

____________________________________________________

Physician's Signature:_______________________ Date: ______

Parent's Signature: __________________________ Date: _______