Medical Exemption. Medical Exemptions will be treated through the district established medical accommodation process and the district will determine the level and ability to accommodate per the individual.
Medical Exemption. Does the infant have a medical exemption? Yes No If the infant has a medical exemption to sleep in a position other than on their back a licensed physician must provide instruction on an alternate sleeping position. The following shall be included with the medical exemption: • Instructions on how the infant shall be placed to sleep, including sleep position. • Duration the exemption is to be in place • The licensed physician’s contact information • Signature of the licensed physician and date of signature ATTACH REQUIRED DOCUMENTS TO THIS FORM AND MAINTAIN IN THE INFANT’S FILE PURSUANT TO TITLE 22, SECTION 101429(a)(2)(c) FOR CHILD CARE CENTERS OR SECTION 102425(c)(2) FOR FAMILY CHILD CARE HOMES. Authorized Representative Signature Date As a Parent/Authorized Representative, you have the right to:
1. Enter and inspect the child care center without advance notice whenever children are in care.
2. File a complaint against the licensee with the licensing office and review the licensee’s public file kept by the licensing office.
3. Review, at the child care center, reports of licensing visits and substantiated complaints against the licensee made during the last three years.
4. Complain to the licensing office and inspect the child care center without discrimination or retaliation against you or your child.
5. Request in writing that a parent not be allowed to visit your child or take your child from the child care center, provided you have shown a certified copy of a court order.
6. Receive from the licensee the name, address and telephone number of the local licensing office. Licensing Office Name: Licensing Office Address: Licensing Office Telephone #: Community Care Licensing
7. Be informed by the licensee, upon request, of the name and type of association to the child care center for any adult who has been granted a criminal record exemption, and that the name of the person may also be obtained by contacting the local licensing office.
8. Receive, from the licensee, the Caregiver Background Check Process form.
Medical Exemption. Does the infant have a medical exemption? ■ Yes ■ No If the infant has a medical exemption to sleep in a position other than on their back a licensed physician must provide instruction on an alternate sleeping position. The following shall be included with the medical exemption: • Instructions on how the infant shall be placed to sleep, including sleep position. • Duration the exemption is to be in place • The licensed physician’s contact information • Signature of the licensed physician and date of signature ATTACH REQUIRED DOCUMENTS TO THIS FORM AND MAINTAIN IN THE INFANT’S FILE PURSUANT TO TITLE 22, SECTION 101429(a)(2)(c) FOR CHILD CARE CENTERS OR SECTION 102425(c)(2) FOR FAMILY CHILD CARE HOMES. Authorized Representative Signature Date LIC 9227 (8/20) Confidential Page 2 of 2 □ All Required Licensing Forms □ Extra clothing (LABELED) (from the list in the ECC handbook) □ Crib sheet and small blanket (for nap) LABELED □ Diapers, Wipes, Cream LABELED □ Sunscreen – LABELED WITH CHILD’S NAME □ 180 pennies for Xxxxxxxx (toddlers only) □ $50 cash (For parent convenience, we collect a fee for supplies, prints, special projects, and earthquake kit.) STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY (CHILD’S PRE-ADMISSION HEALTH EVALUATION) , born is being studied for readiness to enter (NAME OF XXXXX) (BIRTH DATE) . This Child Care Center/School provides a program which extends from : (NAME OF CHILD CARE CENTER/SCHOOL)
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. (SIGNATURE OF PARENT, GUARDIAN, OR CHILD’S AUTHORIZED REPRESENTATIVE) (TODAY’S DATE) Problems of which you should be aware: Hearing: Allergies: medicine: Vision: Insect stings: Developmental: Food: Language/Speech: Asthma: Dental: Other (Include behavioral concerns): Comments/Explanations: MEDICATION PRESCRIBED/SPECIAL ROUTINES/RESTRICTIONS FOR THIS CHILD: POLIO (OPV OR IPV) / / / / / / / / / / DTP/DTaP/ (DIPHTHERIA, TETANUS AND [ACELLULAR] PERTUSSIS OR TETANUSDT/Td AND DIPHTHERIA ONLY) / / / / / / / / / / MMR (MEASLES, MUMPS, AND RUBELLA) / / / / (REQUIRED FOR CHILD CARE ONLY)HIB MENINGITIS (HAEMOPHILUS B) / / / / / / / / HEPATITIS B / / / / / / VARICELLA (CHICKENPOX) / / / / SCREENING OF TB RISK FACTORS (listing on reverse side) ■ Risk factors not present; TB skin test not required. ■ Risk factors present; Mantoux TB skin tes...
Medical Exemption. The unit member will submit a written statement from a 76 licensed medical provider exempting them due to personal disability or serious 77 medical condition. This exemption must be submitted on the provider’s letterhead 78 with the provider’s printed name, license number, signature, and date the 79 exemption was issued. Employees should submit the statement to the Office of 80 Human Resources. 81
Medical Exemption. Medical Exemptions will be treated through the medical 2 accommodation process and the District will determine the level and ability to
Medical Exemption. 42 Medical Exemptions will be treated through the district established medical accommodation 43 process and the district will determine the level and ability to accommodate per the individual.
Medical Exemption. Medical Exemptions have been treated through the district established 7 medical accommodation process and the district has determined the level and ability to 8 accommodate the individual through an interactive process.
Medical Exemption. The Executive Order allows for employees with underlying or pre-existing health conditions be medically excepted from receiving the vaccine and/or receive appropriate accommodations. The Agency shall identify and designate a qualified Medical Professional to receive and review medical exception/accommodation information. Information provided shall be on a form jointly created and agreed to by the Agency and the Union, attached to this MOU as Appendix 2. The Employee may grant authority to the Agency Medical Professional to correspond with their physician to facilitate exemption. Should an employee be denied due to a lack of information, the agency shall inform the employee of the missing required information. The employee shall have 3 business days to provide additional requested information. During this period, the employee shall not be deemed non-compliant and be subject to discipline. If the employee is approved for the exception, the Agency shall provide a letter of exception to the employee. The Agency shall provide to an employee who has been formally excepted from the vaccination requirement: masks, xxxxxxx, sanitizer and other personal protective equipment to assist in maintaining a safe working environment. An employee formally excepted from the vaccination requirement shall be required to disinfect their work area at the conclusion of the work day with Agency-provided materials. The exempted employee shall receive time without loss of pay or benefits to be tested for Covid-19. The agency shall be the responsible party for all expenses related to routine testing. Should an employee be denied an exception to the vaccination requirement, the employee shall be granted two weeks from the denial of the exception, or the deadline given in the Executive Order, whichever date falls later, to comply with the vaccine procedure as detailed in Section A. During this two-week period, the employee shall not be deemed non-compliant with the order nor shall they be subject to discipline for the reason of non-compliance with the vaccination Executive Order.
Medical Exemption. 62.1 A Super Rugby Club must give notice, at any time prior to the Super Rugby Eligibility Date, to any Player:
Medical Exemption. Rugby Club must give notice, at any time prior to the Super Rugby Eligibility Date, to any Player: with whom it is a party to an NZ Rugby Contract with an NZ Rugby Term which encompasses at least the Super Rugby Competition in the following Contract Year (and under which it is that Player’s Agreed Super Rugby Club) and whom it does not intend to select in its Final Super Rugby Squad of 32 NZ Rugby Contracts for the following Contract Year for the reason that the Player has an injury or illness that will prevent the Player from playing for his Super Rugby Team for at least the first six weeks of the Super Rugby Competition in the following Contract Year (as confirmed by the NZRU Medical Director), but that Player is otherwise an Available Player. Prior to giving any such notice, a Super Rugby Club must inform the NZRU and RPC of its intention to not select the Player in its Final Super Rugby Squad and seek the confirmation of the NZRU Medical Director in respect of sub- clause 64.1(b) above. The following provisions apply to Players who are subject to the Medical Exemption described in sub-clause 64.1: The Player will be automatically moved into the NZ Rugby Draft Contract Player group of his Agreed Super Rugby Club for the Contract Year of the relevant Super Rugby Competition only, and is entitled to continue to receive payment of his full NZ Rugby Retainer (and his Provincial Union Retainer, if applicable). For the avoidance of doubt, if the Player is party to an NZ Rugby Contract that extends beyond the relevant Contract Year in which the Medical Exemption applies, he must be in included in the Final Super Rugby Squad of his Agreed Super Rugby Club in subsequent Contract Years unless he is the subject of a further Medical Exemption or is otherwise not an Available Player; Following notification, the Player can be replaced in his Agreed Super Rugby Club’s Initial Super Rugby Squad or Final Super Rugby Squad.
