How to Complete the ODJFS Child Medical Statement for Child Care (JFS 01305)

The JFS 01305 child medical statement is Ohio’s one-page form that every licensed childcare provider must keep on file for each enrolled child. Your pediatrician, physician assistant, advanced practice registered nurse, or certified nurse practitioner examines your child and completes the medical portion; you sign any immunization declination; and you hand the signed form, with your child’s immunization record attached, to your childcare provider within 30 days of the first day of attendance.¹ After that, it gets refreshed every 13 months.²

Which Children Need One

Every child enrolled in a licensed child care center, a licensed Type A or Type B family child care home, or a home with a certified in-home aide needs a current JFS 01305 on file.¹ Infants, toddlers, preschoolers, and younger school-age children are all covered. The one exception: children who attend kindergarten or above in an elementary school do not need the medical statement.³

If a certified in-home aide watches your child, note that the aide must also keep a medical statement on file for their own children who are present during care hours, not only for paying clients’ children.³

Where to Get the Blank Form

Download the current version from the Ohio Department of Job and Family Services forms portal at odjfs.state.oh.us. Many childcare providers also hand out blank copies at enrollment. The form is a single page. Bring a blank copy with you to the appointment, because not every medical office stocks Ohio-specific childcare paperwork.

What You Fill In as the Parent

Your part is small. Print your child’s name and date of birth at the top. If your child will not be receiving one or more required immunizations for reasons of conscience, including religious convictions, sign the declination line and note which diseases are affected. That signature is the only one the form asks a parent to provide.

Everything else on the medical side belongs to the examining professional, so don’t guess at measurements, dates, or vaccine entries yourself.

What the Doctor Fills In

The physician, PA, APRN, or CNP who examines your child completes the rest of the form. They check boxes confirming that the child has been examined, that the immunization status has been recorded, and that the child is in suitable condition for group care. They also check a box affirming the child has been immunized in accordance with Ohio Revised Code 5104.014, or they note any exceptions.¹

The examiner then enters:

Date of examination. This date cannot be more than 13 months before the date the form is signed.²
Signature, printed name, business address, and phone number. All four are required, and a missing address or phone number can make the form incomplete.
Recommended assessments and screenings. The form has checkboxes for vision, lead, hearing, hemoglobin, and dental screenings, plus an open field for anything else.
Height, weight, and BMI.
Any immunization exceptions, with the disease named and the reason noted.

There is a notes field at the bottom of the medical section. This is where asthma action plans, food allergies, medications, and ongoing conditions get flagged for the childcare staff. Parents often skip past it, but it is the first place a director will look when deciding how to care for your child day to day. If your child has any such condition, ask the examiner to write it in rather than leaving the space blank.

The Immunization Record and Exemptions

The JFS 01305 itself doesn’t have lines for individual vaccine doses. You attach a separate immunization record showing the month, day, and year of every dose administered.¹ Your pediatrician’s office can print this from their records system in a minute. The record must show compliance with Ohio Revised Code 5104.014, which tracks the CDC’s recommended childhood immunization schedule.⁴

Ohio recognizes three grounds for skipping a required vaccine:

Medical contraindication, certified by a physician, PA, APRN, or CNP.
Age-inappropriateness, certified by the same types of medical professionals.
Reasons of conscience, including religious convictions, documented by the parent’s signature on the form.²

The conscience exemption is broad. Ohio does not restrict it to organized religion and does not require a letter from a religious leader. Your signature on the declination line, with the diseases named, is enough. Medical exemptions have to come from the examining professional, not from you. Either way, the exemption has to appear on the JFS 01305 or on an attached written statement; telling the childcare director verbally does not satisfy the rule.

One screening worth watching: Ohio law requires healthcare providers to administer a blood lead test at ages one and two, and for any child up to age six who has no record of a prior test. Children enrolled in Medicaid are tested at 12 and 24 months at no cost to the family.⁵ A blank lead-screening checkbox on the form can prompt follow-up from your childcare provider, so make sure the test has been done and recorded.

Turning It In and Keeping It Current

Give the signed form, with the immunization record attached, to your childcare provider’s administrator or director. The facility must have it on file within 30 days of your child’s first day of attendance.¹

After the initial filing, the statement must be updated every 13 months measured from the date of the examination, not from the date you submitted the form.² Each update means a new physical exam and a fresh JFS 01305 signed by the examining professional. If your child gets additional vaccinations between updates, send over an updated immunization record so the file stays accurate. Keep a copy of every signed form for your own records too. Providers have to retain child medical statements for at least 12 months after the form is signed or updated, even after the child leaves the program.³

If the Form Is Missing or Overdue

A missing or expired medical statement is one of the easiest items for a state inspector to catch during a routine licensing visit. For the childcare provider, that means a non-compliance finding and a corrective action plan. For you, the practical consequence is simpler: your provider may not be able to keep your child enrolled while the form is overdue. Providers face their own regulatory consequences for admitting children without documentation, so most set a hard deadline and follow up persistently until the paperwork is in.

If your child’s vaccine schedule or exam appointment is going to run past the 13-month mark, call the provider ahead of time rather than letting the file lapse.

If Your Child Has a Disability or Chronic Condition

A childcare provider cannot refuse to enroll your child simply because the JFS 01305 reveals a disability or chronic medical condition. Title III of the Americans with Disabilities Act requires childcare centers to give children with disabilities an equal opportunity to participate. A provider can exclude a child only if the child’s presence would pose a direct threat to others’ health or safety, or if accommodating the child would fundamentally alter the program, and that determination must rest on an individualized assessment rather than assumptions about the diagnosis.⁶

Higher insurance costs tied to serving children with disabilities are not a valid reason for exclusion. If your child needs one-on-one support and an outside party (a government program or a privately hired aide, for example) provides it at no cost to the center, the provider cannot reject your child on that basis alone.⁶

1
Ohio Legislative Service Commission. Ohio Administrative Code 5180:2-12-15 – Child Record Requirements for a Licensed Child Care Center
2
Ohio Legislative Service Commission. Ohio Administrative Code 5180:2-13-15 – Child Record Requirements for a Licensed Family Child Care Provider
3
Legal Information Institute. Ohio Admin Code 5101:2-14-06 – Child Record Requirements for a Certified In-Home Aide
4
Centers for Disease Control and Prevention. Healthcare Professionals: Child and Adolescent Immunization Schedule by Age
5
Centers for Disease Control and Prevention. Testing for Lead Poisoning in Children
6
ADA.gov. Commonly Asked Questions About Child Care Centers and the Americans with Disabilities Act