Medical Conditions Acknowledgement Form
About the Medical Conditions Acknowledgement Form
A digital medical conditions acknowledgement form that allows parents to provide comprehensive medical condition information for their child's enrolment record. Under Regulation 90, services must have a medical conditions policy and parents must provide a medical management plan. This form captures the condition type, treating practitioner details, management plan upload, medication requirements, known triggers, symptoms to watch for, and emergency response steps.
Also called
- Medical conditions form
- Medical management acknowledgement
- Medical conditions policy acknowledgement
What's on this form
Every question included in the medical conditions acknowledgement form. Add, remove or reword any of them in the form builder.
Form questions
Child Details
Child details
Medical Condition Details
Type of Medical Condition
- Asthma
- Anaphylaxis
- Diabetes
- Epilepsy
- Other
Choose one
Description of Condition
Long answer
Treating Practitioner
Doctor/Specialist Name
Short answer
Doctor/Specialist Contact Number
Mobile
Medical Management Plan
Plan Date / Last Updated
Date
Plan Review Date
Date
Medication Details
Does your child require medication to be kept at the service?
Yes / No
Medication Name
Short answer
Dosage
Short answer
Administration Instructions
Long answer
Storage Requirements
Short answer
Risk Minimisation
Known Triggers (things to avoid)
Long answer
Signs and Symptoms to watch for
Long answer
Emergency Response
First Response Steps (what to do in an emergency)
Long answer
Declaration
Medical Management Plan
I have provided the service with a current medical management plan for my child signed by a registered medical practitioner.
Notification of Changes
I will notify the service immediately of any changes to my child's medical condition, management plan, or medication requirements.
Parent/Guardian Signature
Signature
Australian regulations this form supports
The medical conditions acknowledgement form is built around the Education and Care Services National Regulations. These are the regulations it helps you meet.
Medical conditions policy
Services must have a medical conditions policy covering management of conditions including asthma, diabetes, and anaphylaxis. Parents must provide a medical management plan and a risk minimisation plan must be developed.
Read the full text of Reg 90
(1) The medical conditions policy of the education and care service must set out practices in relation to the following— (a) the management of medical conditions, including asthma, diabetes or a diagnosis that a child is at risk of anaphylaxis; (b) informing nominated supervisors and staff members of, and volunteers at, the service of practices in relation to managing those medical conditions; (c) the requirements arising if a child enrolled at the education and care service has a specific health care need, allergy or relevant medical condition, including— (i) requiring a parent of the child to provide a medical management plan for the child; and (ii) requiring the medical management plan to be followed in the event of an incident relating to the child's specific health care need, allergy or relevant medical condition; and (iii) requiring the development of a risk-minimisation plan in consultation with the parents of a child— (A) to ensure that the risks relating to the child's specific health care need, allergy or relevant medical condition are assessed and minimised; and (B) if relevant, to ensure that practices and procedures in relation to the safe handling, preparation, consumption and service of food are developed and implemented; and (C) if relevant, to ensure that practices and procedures to ensure that the parents are notified of any known allergens that pose a risk to a child and strategies for minimising the risk are developed and implemented; and (D) to ensure that practices and procedures ensuring that all staff members and volunteers can identify the child, the child's medical management plan and the location of the child's medication are developed and implemented; and (E) if relevant, to ensure that practices and procedures ensuring that the child does not attend the service without medication prescribed by the child's medical practitioner in relation to the child's specific health care need, allergy or relevant medical condition are developed and implemented; and (iv) requiring the development of a communications plan to ensure that— (A) relevant staff members and volunteers are informed about the medical conditions policy and the medical management plan and risk minimisation plan for the child; and (B) a child's parent can communicate any changes to the medical management plan and risk minimisation plan for the child, setting out how that communication can occur. (2) The medical conditions policy of the education and care service must set out practices in relation to self-administration of medication by children over preschool age if the service permits that self-administration. (3) In subregulation (2), the practices must include any practices relating to recording in the medication record for a child of notifications from the child that medication has been self-administered.
Health information to be kept in enrolment record
The enrolment record must include details of any specific health care needs, including any medical condition and any medication, dietary restrictions, or allergies.
Read the full text of Reg 162
The health information to be kept in the enrolment record for each child enrolled at the education and care service is— (a) the name, address and telephone number of the child's registered medical practitioner or medical service; and (b) if available, the child's Medicare number; and (c) details of any— (i) specific healthcare needs of the child, including any medical condition; and (ii) allergies, including whether the child has been diagnosed as at risk of anaphylaxis; and (d) any medical management plan, anaphylaxis medical management plan or risk minimisation plan to be followed with respect to a specific healthcare need, medical condition or allergy referred to in paragraph (c); and (e) details of any dietary restrictions for the child; and (f) the immunisation status of the child; and (g) if the approved provider or a staff member or family day care educator has sighted a child health record for the child, a notation to that effect.
Provided for information only and may not reflect the latest amendments. Refer to the Education and Care Services National Regulations (NSW) for the official legal text.
Where this form fits
The medical conditions acknowledgement form is part of these jobs — each guide walks through the whole sequence and the other forms that go with it.
Enrolling a child: the forms you need
The enrolment record itself, plus the booking, emergency contacts, medical conditions and standing authorisations that go with it.
Forms parents and guardians fill in
Every form you send out to families — enrolment, permissions, collection arrangements, medication authority and feedback.
Questions about the medical conditions acknowledgement form
What is the medical conditions acknowledgement form used for?
A digital medical conditions acknowledgement form that allows parents to provide comprehensive medical condition information for their child's enrolment record. Under Regulation 90, services must have a medical conditions policy and parents must provide a medical management plan. This form captures the condition type, treating practitioner details, management plan upload, medication requirements, known triggers, symptoms to watch for, and emergency response steps.
Who fills in the medical conditions acknowledgement form?
The medical conditions acknowledgement form is completed by a parent or guardian. You send them a secure link by email or SMS — they don't need an account, an app, or a password to fill it in and sign.
Which Australian regulations does the medical conditions acknowledgement form meet?
It is built around Reg 90 and Reg 162 of the Education and Care Services National Regulations. Reg 90 covers medical conditions policy. Reg 162 covers health information to be kept in enrolment record. Every question the regulations require is already on the form.
Is the medical conditions acknowledgement form the same as a medical conditions form?
Yes. Different services use different names for this form — it is also called medical conditions form, medical management acknowledgement and medical conditions policy acknowledgement. They all describe the same record, and this template covers it. You can rename it to whatever your service already calls it.
Can I change the questions on the medical conditions acknowledgement form?
Yes. The template comes with 25 fields ready to go, but you can add, remove, reword or reorder anything in the drag-and-drop form builder, and add your own conditional logic and signing steps. Your changes only affect your service's copy.
Is the medical conditions acknowledgement form free?
Yes — the medical conditions acknowledgement form is free to use on the Childcare Forms free plan. No credit card is required to create an account and start sending it.
Ready to use it?
Create a free account, change anything you want, and send it to your first family. No credit card needed.
