Medical & Dental Forms
Periodic Medical and Dental exams, and Developmental Assessments, are required by the State of Michigan for all children in foster care. Well-Child Exams are more frequent for infants, and gradually taper off to once per year at age three. Dental Exams are required starting age one year, and then every 6 months thereafter. Developmental Assessments begin at age 6 months, and are generally due at the same ages Well-Child exams. See the schedule below for details, and for links to download the required forms for each visit.
Psychotropic Medication Consent is required for a number of prescription medications including those used to treat ADHD, anxiety, and other emotional, psychiatric or behavioral conditions. Ask your case worker if you have any question whether a child in your care needs Consent to take any medication they have been prescribed. You must obtain Consent before giving such medications to a child in foster care. Download the Psychotropic Medication Informed Consent form (DHS-1643), have your child's Psychiatrist or PCP complete and sign it, then return it to Fostering Futures for finalization. You can download an editable Word document HERE, or a PDF version HERE.
“Failure to include all required medical, developmental and dental forms in a foster child’s file could result in the State of Michigan considering the foster parents and/or agency as medically negligent!”
TIPS FOR YOUR NEXT WELL-CHILD VISIT
BEFORE YOUR APPOINTMENT, make sure you have all the forms you need; they can be downloaded by clicking on the form name in the chart below. If a Developmental Assessment is also required for your child's age (see chart below), it should be completed by the child's foster parents and/or Case Manager BEFORE the Well-Child Exam. The completed Developmental Assessment form (ASQ, PSC or PSC-Y) should then be taken to the Well-Child Exam, along with the age-required Well-Child Exam (WCE) form, so the doctor can use it to complete their assessment (this will also save you time during your appointment).
AT THE DOCTOR'S OFFICE, please ensure the doctor completes EVERY section of the Well-Child Exam form, and signs / dates each page. The doctor may encourage you to leave the form with them, to complete "later" and send to our office for you; however, we have a very low rate of success with receiving medical forms unless the foster parents leave with them in-hand. Also, doctors frequently skip over the developmental section of the Well-Child form (page 2 or 3), but this section is NOT optional at any age. If at all possible, you should leave the doctor's office with a completed Well Child Exam (WCE) form AND the completed Developmental Assessment form (ASQ or PSC) if one is required for your child's age.
SCHEDULE AND FORMS
Well-Child medical examinations, developmental assessments, and Dental visits are required at different age intervals, as shown in the schedule below. The required forms for each age can be downloaded by clicking on the form name in the table. Also, ASC forms can be completed online or downloaded from Easter Seals by clicking the large "ASQ ONLINE" button below the table. (The Easter Seals website will ask for your child's birth date, and automatically give you the right form). If you have any questions about this schedule, or which forms are required at each age, your Case Manager will be happy to help!
| CHILD'S AGE | WELL CHILD EXAM FORM | DEVELOPMENT | DENTAL* |
|---|---|---|---|
| 1 Week | WCE 1 Week (DHS-580) | -- | -- |
| 4 Weeks | WCE 4 Weeks (DHS-579) | -- | -- |
| 2 Months | WCE 2 Months (DHS-583) | -- | -- |
| 4 Months | WCE 4 Months (DHS-581) | -- | -- |
| 6 Months | WCE 6 Months (DHS-1641) | ASQ 6M | -- |
| 9 Months | WCE 9 Months (DHS-1638) | -- | -- |
| 12 Months | WCE 12 Months (DHS-1639) | ASQ 12M | DHS-1664 |
| 15 Months | WCE 15 Months (DHS-1640) | -- | -- |
| 18 Months | WCE 18 Months (DHS-1631) | ASQ 18M | DHS-1664 |
| 2 Years | WCE 2 Years (DHS-1632) | ASQ 2Y | DHS-1664 |
| 30 Months | WCE 30 Months (DHS-1633) | ASQ 30M | DHS-1664 |
| 3 Years | WCE 3 Years (DHS-1634) | ASQ 3Y | DHS-1664 |
| 4 Years | WCE 4 Years (DHS-1642) | ASQ 4Y | DHS-1664 |
| 5 Years | WCE 5 Years (DHS-1635) | ASQ 5Y | DHS-1664 |
| 6 to 10 Years | WCE 6-10 Years (DHS-381) | PSC | DHS-1664 |
| 11 to 14 Years | WCE 11-14 Years (DHS-1636) | PSC or PSC-Y | DHS-1664 |
| 15 to 18 Years | WCE 15-18 Years (DHS-1637) | PSC or PSC-Y | DHS-1664 |
* Dental exams are REQUIRED every six months, starting at one year of age, and must be documented on the "Youth Yearly Dental Record" form (DHS-1664). HOWEVER, children should be seen sooner if any of the below circumstances apply. Documentation of such visits must be added to the child's foster care record (provided to the agency), and could either be made on a DHS-1664 form, or on a report from the Dental Practice. Reasons to seek dental care before age 1, or between annual exams:
If the child is referred for dental care by their pediatrician
If baby teeth have not erupted by age 6 months
If the child's teeth are discolored, broken, grossly misaligned or misshapen
If the child's gums are swollen, bleeding, discolored, and/or the child has persistent unexplained bad breath
If the child complains of persistent oral pain or discomfort not associated with normal teething
If the dentist recommends a return visit sooner than 6 months
If you have any concerns about the oral health of the child that has not been addressed by their pediatrician or dentist