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The SFN 847 form, known as the Parent's Statement on Health of Child, plays a crucial role in ensuring the well-being of children enrolled in licensed early childhood facilities. This form must be completed annually by a parent or guardian, providing essential health information about the child. Key details include the child's full legal name, birth date, and enrollment date, alongside contact information for the parent or guardian. The form also requires information about the child's medical history, including any allergies, current medical treatments, and medications taken daily. Additionally, it addresses specific health conditions such as asthma, diabetes, and behavioral issues, allowing caregivers to understand any limitations the child may have in participating in early childhood programs. A health care plan, if applicable, should also be attached. Parents are reminded to review their child care provider's liability insurance coverage, as it is not mandated for licensing. Finally, the form concludes with a certification section, where the parent or guardian attests to the accuracy of the provided information, ensuring that the child's health needs are appropriately communicated and addressed.

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Similar forms

The SFN 847 form, known as the Parent's Statement on Health of Child, is essential for ensuring the well-being of children in licensed early childhood facilities. Several other documents share similarities with the SFN 847 form, as they also require parental input regarding a child's health and well-being. Below are six such documents, each outlined for clarity.

  • Child Health Assessment Form: This document collects comprehensive health information about a child, including medical history, immunization records, and any existing health conditions. Like the SFN 847, it requires input from a parent or guardian and is often used during enrollment in educational or childcare settings.
  • Emergency Contact Form: This form is crucial for childcare providers to have immediate access to a child's emergency contacts. It typically includes health information and allergies, similar to the SFN 847, ensuring that caregivers can act swiftly in case of an emergency.
  • Medication Authorization Form: When a child requires medication during school or childcare hours, this form must be completed by a parent or guardian. It details the medication, dosage, and administration times, paralleling the SFN 847's focus on a child's health needs.
  • Alabama Bill of Sale Form: When conducting transactions, refer to our detailed Alabama bill of sale form instructions to comply with legal standards.
  • Immunization Record: This document provides a detailed account of a child's vaccinations. Parents must submit this record to comply with state regulations for school and childcare enrollment, mirroring the SFN 847’s requirement for health-related disclosures.
  • Special Needs Assessment Form: For children with identified special needs, this form gathers information about specific requirements and accommodations. It is similar to the SFN 847 as it aims to ensure that the child receives appropriate care and support in an educational setting.
  • Health Care Plan: If a child has a chronic condition, a health care plan outlines necessary treatments and accommodations. This document, like the SFN 847, requires detailed information from parents to ensure that the child’s health is managed effectively while in care.

Each of these documents plays a vital role in safeguarding children's health and ensuring they receive the appropriate care and attention in educational settings. Parents and guardians should be diligent in completing these forms accurately and thoroughly.

How to Use Sfn 847

Filling out the SFN 847 form is an important step in ensuring that your child’s health information is accurately documented for their enrollment in a licensed early childhood facility. By providing complete and accurate details, you help caregivers understand your child's health needs. Follow these steps to fill out the form correctly.

  1. Begin by entering the Full Legal Name of Child and their Birth Date.
  2. Next, provide the Enrollment Date and check the appropriate box for the type of enrollment: FT (Full-Time), PT (Part-Time), or Drop-in B/A School.
  3. Fill in the Full Legal Name(s) of Parent or Guardian and their Relationship to the child.
  4. Complete the Address, City, State, and ZIP Code fields.
  5. Provide the Home Telephone Number and Work Telephone Number.
  6. List the Family Dentist and Family Physician, along with the Clinic name and Telephone Number.
  7. Indicate the Hospital name and its Telephone Number.
  8. Document the Last Visit to Doctor, Child's Height, and Child's Weight.
  9. Answer whether the child has any food, medication, or environmental allergies by checking Yes or No. If yes, list the allergies, describe the allergy reaction, and usual treatment.
  10. Check any of the following conditions that exist: Asthma, Heart Condition, Hearing Impairment, Behavioral Issues, Diabetes, Seizure Disorder, Frequent Earaches, Other Conditions, or Vision Impairment. Provide explanations for any checked items.
  11. Indicate if the child is under current medical treatment by checking Yes or No. If yes, list the treatments.
  12. Answer whether there are any medications that the child takes daily by checking Yes or No. If yes, list the medications.
  13. Describe any limitations your child may have for participation in an early childhood program.
  14. Indicate if there is a health care plan for your child by checking Yes or No. If yes, attach the plan.
  15. Finally, review the liability insurance information and sign the form. Provide the Parent or Guardian's Signature and the Date.

Dos and Don'ts

When filling out the SFN 847 form, it’s important to approach the task with care and attention to detail. Here are some key do's and don'ts to keep in mind:

  • Do provide accurate and complete information about your child’s health.
  • Do check for any allergies and describe reactions clearly.
  • Don't leave any sections blank; if something doesn’t apply, indicate that.
  • Don't forget to sign and date the form before submission.

Document Example

File Breakdown

Fact Name Description
Form Title This form is officially titled "Parent's Statement on Health of Child." It is identified as SFN 847.
Governing Law The SFN 847 form is governed by North Dakota state law, specifically regulations concerning licensed early childhood facilities.
Purpose The primary purpose of this form is to gather essential health information about a child enrolled in an early childhood program.
Annual Requirement Parents or guardians must complete this form annually for each child enrolled in a licensed early childhood facility.
Information Collected The form collects various details, including the child's name, birth date, allergies, and any medical conditions.
Signature Requirement A parent or guardian must sign the form to certify that the information provided is accurate and complete.
Health Care Plan Parents are asked whether their child has a health care plan, and if so, they should attach it to the form.
Insurance Note The form includes a note stating that liability insurance is not required for a license to provide family or group child care.
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Common mistakes

When filling out the SFN 847 form, one common mistake is failing to provide complete information about the child's allergies. This section is crucial as it helps ensure the safety of the child in an early childhood facility. Parents often check "No" without considering that their child may have less obvious allergies. It is important to list any known food, medication, or environmental allergies, as well as the reactions and treatments. Omitting this information can lead to serious health risks.

Another frequent error involves neglecting to describe any existing medical conditions. The form includes a checklist for conditions such as asthma, diabetes, and behavioral issues. Parents sometimes overlook this section or fail to explain checked items adequately. Providing detailed information about these conditions is essential for the child's care and can significantly impact how staff respond to any health needs during the child's time in the facility.

In addition, many parents forget to indicate whether their child is currently under medical treatment. This is a critical piece of information that should be clearly stated on the form. If the answer is "Yes," parents must list the treatments and medications. Without this information, caregivers may not be aware of the child's medical requirements, potentially leading to misunderstandings or inadequate care.

Lastly, parents often neglect to sign and date the certification section of the form. This signature confirms that the information provided is accurate to the best of their knowledge. An unsigned form may be deemed incomplete and could delay the enrollment process. It is vital to ensure that all sections are filled out correctly and that the form is signed before submission.

FAQ

What is the SFN 847 form?

The SFN 847 form, also known as the Parent's Statement on Health of Child, is a document required by the North Dakota Department of Human Services. It must be completed annually for any child enrolled in a licensed early childhood facility. The form gathers important health information about the child from a parent or guardian.

Who needs to fill out the SFN 847 form?

The form must be completed by a parent or guardian of the child. It is essential for ensuring that the early childhood facility has the necessary health information to provide appropriate care for the child.

What information is required on the SFN 847 form?

The form requires details such as the child's full legal name, birth date, and enrollment date. It also asks for the parent's or guardian's name, contact information, and the names of the child's family dentist and physician. Additionally, it includes sections on allergies, medical conditions, medications, and any limitations the child may have.

Why is it important to disclose allergies on the SFN 847 form?

Disclosing allergies is crucial for the safety of the child. If a child has food, medication, or environmental allergies, this information helps caregivers take necessary precautions to avoid exposure and manage any allergic reactions effectively.

What should I do if my child has a medical condition?

If your child has a medical condition, it is important to check the appropriate box on the form and provide a detailed explanation. This ensures that the early childhood facility is aware of any specific needs or treatments that may be required for your child.

Is there a section for medications on the SFN 847 form?

Yes, the form includes questions about any medications your child takes daily. If your child is on medication, you should list these medications to inform the caregivers about any necessary health management during their time at the facility.

What if my child is under current medical treatment?

If your child is receiving medical treatment, you should indicate this on the form and provide details. This information is important for the caregivers to understand your child's health status and any potential needs while at the facility.

Do I need to attach any additional documents?

If your child has a health care plan, you should attach a copy of that plan to the SFN 847 form. This helps the facility understand the specific health care needs and strategies in place for your child.