CCMPL 39 (New Sample Form, JFS 01585 (5/2009))
Child Care Manual Procedure Letter No. 39
June 10, 2009
TO: All Child Care Center Manual Holders
FROM: Douglas E. Lumpkin, Director
SUBJECT: New Sample Form for Child Care

This letter transmits a new sample form, JFS 01585 "Medication Label for Child Care Providers" (5/2009) to use when a child in their care is taking medication. This label can be affixed to a plastic bag which contains the items listed in order to keep all medication, equipment, and necessary forms located together.

The information on the sample form is designed to be copied and pasted onto 3 ½" X 4" shipping labels, in order to produce multiple labels which can then be adhered directly to a sealable bag.

JFS forms can be found online at: If you have questions or concerns about this form, please contact your licensing specialist or the Office of Families and Children Help Desk at 1-866-886-3537, option 4.

INSTRUCTIONS: The following chart identifies the material that needs to be removed from the Child Care Manual (CCM) and materials that are to be inserted into the CCM.

CCM Appendix JFS 01585
CCM Procedure LettersCCMPL No. 39