Collect samples of child health history forms from several child care programs in your area, in early childhood education resource books, and/or online resource websites.

Collect samples of child health history forms from several child care programs in your area, in early childhood education resource books, and/or online resource websites. Then, create your child’s health history form that you would use at a daycare or preschool. Do not create a form for a doctor’s office or health department.

You need to take into consideration the information discussed in chapter 9. We know the importance of health records, screening, and daily health checks. We also know that we can initiate the referral process with more credibility once we have gathered appropriate data.

Example Download Examplechild health history form assignment document. Please review this assignment example.

This assignment is worth 40 points total.

Your form will be graded on the following criteria:

The form should be easy to read, well organized, and with adequate space to answer each question. (20 points)

The form should include a parent/guardian contact section that requests the parent/guardian’s name, address, and phone. (5 points)

The form should request child health information that includes auditory, speech, vision, and general health and development. (10 points)

1 or 2-paragraph(s) justification should be included. The paragraph(s) should be written with correct spelling and grammar and include why the student requested specific information on the form. This justification paragraph(s) should be included at the end of the form. (5 points)

The justification paragraph should also include at least 3 reference sample child health history forms – state the name of the form and the resource in the paragraph. You can also include the webpage link if it was an online form. This information should be included in the justification paragraph(s) discussed above. (5 points)

Sample attached.