How to Fill Out the Ohio JFS 01236 Child Medical/Physical Care Plan

To fill out the Ohio JFS 01236 Medical/Physical Care Plan for Child Care, you work through four parts in order: a child information block at the top of page one, Part I where the parent describes the condition, Part II where a licensed healthcare professional writes the medication orders, Part III where trainers and staff sign off, and Part IV where the facility logs every dose going forward. The form must be on file before your child’s first day of attendance or as soon as a health condition is confirmed.¹

Before You Start

Download the current JFS 01236 (Rev. 3/2022) free from the Ohio Department of Job and Family Services Forms Central page, or ask your provider for a blank copy at enrollment. The form runs four pages, and Part II has to be completed by your child’s doctor or nurse practitioner, so build in at least one medical appointment before your care start date. The most efficient approach is to fill out Part I at home, bring the form to the appointment, and let the healthcare provider complete and sign Part II while you are there.

One structural rule to know up front: you need a separate JFS 01236 for each condition that calls for different care actions. A child with both a peanut allergy and Type 1 diabetes needs two forms on file, not one combined plan.² The same requirement applies whether your child attends a licensed center or a licensed family child care home.³

Child Information at the Top of Page 1

Write the child’s full name, date of birth, and current weight. Weight matters because some medication doses are calculated from it. If weight has no bearing on the condition, you can leave that field blank.⁴

Part I: What the Parent Writes

Part I is yours. You describe the condition in your own words so caregivers know what to watch for and what to do. Three fields do the real work.

The first asks for signs, symptoms, or situations that require staff action. Be concrete. Instead of writing “allergic reaction,” describe what a caregiver will actually see: hives, swelling around the mouth, difficulty breathing, vomiting. A caregiver reading your sentence in a stressful moment should be able to match it to what is in front of them within seconds.

The second field covers activities, foods, or environmental conditions to avoid. List every trigger you know of. For a food allergy, name the exact allergen and the common foods it hides in. For asthma, note things like cold air, heavy exercise, or exposure to certain animals.

The third field asks for training instructions for procedures staff must follow. Write out every step, start to finish, as if the reader has never done it before. This is the script a caregiver will follow in real time, so include recognition, intervention, and what counts as “done.”

You also check a box indicating whether the condition requires medication or medical food. If it does, the form moves into Part II.⁴

Part II: What the Healthcare Professional Writes

Part II has to be filled in by a licensed physician, dentist, advanced practice registered nurse, or certified physician assistant. Nobody else qualifies, so a form that comes back without one of those signatures is incomplete.

The provider documents the symptoms that would call for medication or medical food, the exact administration instructions (dosage, route, and timing), and the actions staff should take if symptoms do not subside. That last field matters: it tells caregivers whether to give a second dose, call 911, contact you, or do all three. The section has space for up to three medications, each with name, dosage, time of administration, and expiration date. The provider signs and dates the section.⁴

One rule often catches parents off guard. The childcare program cannot administer a medication until your child has received at least one dose outside the program, so staff can be confident no unexpected reaction will happen on their watch. Emergency medications like epinephrine are exempt from that first-dose requirement.

Part III: Training Authorization and Signatures

Part III is where most incomplete forms fall apart, because it collects several signatures from several different people.

Start with the evacuation question. Check whether medication, supplies, or physical assistance must leave the building with your child during an evacuation. Ohio regulations require the plan to be portable enough to travel with the child to an alternate location, so these boxes are not optional detail.

Next comes the training block. If you are training the staff yourself on your child’s care, you sign on the parent-trainer line. If a nurse, doctor, or other certified professional is doing the training instead, that person provides their name, signature, phone number, and date, and you also sign to authorize it.

Then every staff member who has been trained to care for your child’s condition prints their name, signs, and dates the form. This is strict: only staff who have signed the JFS 01236 are permitted to care for that child’s condition, substitutes included. Finally, the facility administrator or family child care provider signs last, confirming that the plan is complete and on file.

The bottom of Part III also holds a line for annual-review initials, which you and the administrator will use when you revisit the form each year.²

Part IV: The Medication Administration Log

Part IV is not something you fill out at the start. It is an ongoing record kept with the form at the facility. Each time staff give medication or medical food, they log the child’s name, medication name, date, time, dosage, and their signature. State licensing specialists review this log during inspections, so expect your provider to treat it as a running document rather than a one-time entry.⁴

Mistakes That Send the Form Back

A handful of recurring problems cause JFS 01236s to be rejected at enrollment or flagged during licensing inspections:

Missing healthcare professional signature on Part II when the condition involves medication. A parent description is not enough on its own.
Vague symptom descriptions like “child may have a reaction.” Caregivers need observable signs: skin flushing, wheezing, confusion, trembling.
Expired medication listed on the form. The expiration date field is checked against the actual medication on the shelf.
Missing signatures from staff who care for the child. A new teacher who joined the classroom mid-year and hasn’t signed creates a compliance gap.
Blank evacuation boxes when your child has emergency medication. Inspectors treat that omission as a red flag.

Keeping the Form Current

Once the form is on file, it stays accessible to staff on-site in a spot they can reach fast enough to grab during an evacuation.¹ You review it with the administrator at least once a year, and both of you initial and date the review line to confirm that the information and the trained-staff list are still accurate.

If anything changes between annual reviews, update the form right away rather than waiting for the yearly cycle. New medication, a dosage adjustment, a new diagnosis, or a new staff member who will care for your child all call for an update. The facility is required to keep each JFS 01236 on file for at least one year after your child leaves the program.³

1
Ohio Legislative Service Commission. Ohio Administrative Code 5180:2-12-15 – Child Record Requirements for a Licensed Child Care Center
2
Legal Information Institute. Ohio Admin Code 5101:2-12-15 – Child Record Requirements for a Licensed Child Care Center – Section: (C) Health Care Plan Requirements
3
Legal Information Institute. Ohio Admin Code 5101:2-13-15 – Child Record Requirements for a Licensed Family Child Care Provider – Section: (C) Health Care Plan Requirements
4
Ohio.gov. CCMPL 151 – Revised Child Care Forms