Instructions for the dhs 908

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The DHS 908 Early Childhood Pre-K Health Record Supplement (EC Pre-K HRS) form was created with the assistance of the Healthy Child Care Hawaii, a collaborative project of the University of Hawaii/School of Medicine - Department of Pediatrics, American Academy of Pediatrics - Hawaii Chapter, Department of Health/Children with Special Health Needs Branch. The purpose of the DHS 908 is to provide developmentally appropriate information on the child’s health, growth and developmental status for entrance into a Pre-Kindergarten (Pre-K) program which includes an Infant and Toddler Child Care Center (IT), Group Child Care Center (GCC), and Group Child Care Home (GCH). The child’s physician is requested to complete the DHS 908 in conjunction with the Department of Education (DOE) Form 14.

  1. A health record shall be required and obtained from the parent or guardian of each child entering a licensed child care facility such as a Family Child Care Home (FCC), GCC, GCH, or an IT and be kept on file at the facility in accordance with the applicable Hawaii Administrative Rules (HAR) §§17-891.1-20, 17-892.1-20, and 17-895-20.

  2. The Department of Education (DOE) Student Health Record “Form 14” (F14) shall be used to comply with this requirement listed in #1, or a comparable writing (documentation) of a child’s current immunizations, evidence of child’s good health/physical examination results, and TB test/clearance results. The F14 (rev. 2010) is available and may be downloaded from the DOE website,

  3. In addition, the records of each child in a GCC, GCH, and IT shall include pertinent information about the health status (including Body Mass Index), developmental progress, and any special needs and efforts necessary to meet these needs in accordance with HAR §§17-892.1-20(c) and 17-895-20(c). The DHS 908 or comparable writing (document) shall be used to comply with the requirement listed in #2. The DHS 908 may be downloaded from the DHS Child Care Connection Hawaii website,

  1. At the time of a facility’s initial licensing visit, each child shall have a F14 and a DHS 908 on file.

  2. At the time of a facility’s annual licensing visit, new students enrolled for the school year who do not have a F14 on file shall, also, be required to have a DHS 908 on file.

  3. Children entering new programs that were previously enrolled at a licensed child care program with a DHS 908 form that was signed by an approved health care practitioner within 12 months of admission do not need to update their form;

  4. Furthermore, providers shall issue the DHS 908 form (09/15) version to all families when families request the F14 on file to update their form due to an upcoming well-child visit or immunization scheduled with the health care practitioner. Providers shall instruct families to have the health care practitioner complete the DHS 908 form (09/15) to keep the program informed of the child’s on-going growth and development while the child is enrolled in the program.

  5. The facility’s director shall document at least 2 attempts to obtain the DHS 908 from the parent. If after 2 attempts the DHS 908 is not returned, the child’s health requirement shall be met as long as the F14 is on file.

  6. If a child has a medical condition noted on the F14 or the physician has marked “Yes” in Box 6 of the DHS 908 that a Special Care Plan should be developed, the child care facility should develop a Special Care Plan for the child and kept on file at the facility. Please refer to the “Sample Special Care Plan” on page 4 of the DHS 908.

  7. The DHS 908 is only recommended for entry into a FCC.

  8. A FCC and GCH provider’s own children who are enrolled in school and school-aged children enrolled in the FCC or GCH for before and after school care who satisfy health requirements for enrollment in school are not required to furnish evidence of the child’s health.

  9. Children enrolled in licensed before and after school child care facilities (BAS) are not required to furnish evidence of the child’s health per

HAR §17-896-19(a).

DHS 908A (09/15) page of 2

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