OCFS-6004. Staff, Volunteer, and Household Member Medical Statement

The OCFS-6004 Staff, Volunteer, and Household Member Medical Statement is a form used by the New York State Office of Children and Family Services (OCFS) to ensure the health and safety of children in care.

The main purpose of the form is to collect medical information about staff, volunteers, and household members who have direct contact with children in child care programs. The form is used to identify any medical conditions or treatments that may affect the individual's ability to safely interact with children.

The form consists of several sections, including personal information, medical history, immunizations, and tuberculosis screening. The important fields that need to be filled out include the individual's name, date of birth, medical conditions, medications, and vaccination history.

The parties involved in the form are the individual completing the form and the child care program or agency that is requesting the form.

When writing the form, it is important to consider providing accurate and complete information, as well as attaching any necessary medical documentation or records.

Practice and use cases for the form include child care providers, foster care agencies, and other programs that involve direct contact with children. By collecting medical information, the form helps ensure the safety and well-being of children in care.

Strengths of the form include its ability to identify potential health risks and ensure a safe environment for children. Weaknesses may include the potential for incomplete or inaccurate information, as well as the need for additional medical documentation.

Related and alternative forms may include medical release forms or health assessment forms used by other child care programs or agencies.

The form affects the future of the participants by providing a record of their medical history and ensuring their ability to safely interact with children.

The completed form is typically submitted to the child care program or agency that is requesting the form, and is stored in the individual's file for future reference.