4.26.1 Medical Passport



Practice Guidance

  • Forms in the medical passport document information such as: 
    • Authorization for the child’s medical treatment; 
      • To be updated when there is any type of custody change; 
      • Telephone numbers for the FSOS, SSW and after hours contact should be provided in order to obtain consent as needed;
    • Information about payments for medical services; 
    • Physical health examinations and treatment; 
    • Medications the child is taking; 
    • Medical history; 
    • Immunizations; 
    • Allergies; 
    • Mental health screening; 
    • Dental Care; and 
    • Visual screening. 
  • Medical Passport forms include: 
    • ​DPP-105 Medical Information on the Child’s Birth (used when taking custody of a newborn from a hospital); 
    • DPP-106A Authorization for Routine Health Care and Authorizatino for Non-Routine Health Care (refer to SOP 4.26.2 Authorization for Medical Services); 
    • DPP-106B Initial Physical and Behavioral Health History (used only upon entry into care to capture child and family's medical history); 
    • DPP-106D Medical Appointment (used for any ongoing medical appointments occurring between the annual physical exam); 
    • DPP-106E Dental Appointment (used for both initial, annual, and any appointments occurring between the annual dental exam); 
    • DPP-106F Visual Screening (used for both initial, annual, and any appointments occurring between the annual visual exam); 
    • DPP-106G Mental Health Screening (used for both initial screening and any ongoing mental health appointments); 
    • DPP-106H Prescription and OTC Medication Administration (used by foster parent/caregiver to document all medication uses as described in SOP 12.10 Rights/Responsibilities of DCBS Foster/Adoptive Home Parents); 
    • DPP-106I Methamphetamine Exposure Medical Evaluation and Follow-Up Form as referenced in SOP 2.12 Children Exposed To Meth Labs; and 
    • DPP-106J Medication Transfer Form (used by foster parent/caregiver to document all medications being transferred from one placement to another). 
    • ​The Immunization Certificate provided by the child's physician. 
  • Foster parents are to maintain the medical passport. It is the responsibility of DCBS staff to ensure that the medical passport remains with the child, and current, throughout their time in OOHC and through any placement moves. 
  • ​ A duplicate copy of the medical passport should be provided to the parents or relatives if the child is returned home, and the original will become part of the child’s case file.


The SSW:

  1. Follows procedures outlined in SOP 4.26 Meeting Basic Health Care Needs; 
  2. Provides the medical passport to the caregiver upon initial removal and ensures the medical passport stays with the child throughout his/her stay in out of home care (OOHC); 1 
  3. Utilizes the medical passport forms, or documentation provided by the medical/mental health professional, to document the physical and mental health care services that a child received prior to entry, and after entry into OOHC; 
  4. Provides the child’s medical passport to the child’s custodian and maintains a copy of the medical passport in the case file when the child is released from Cabinet commitment.


  1. Documentation from the medical provider may be used in place of the forms as long as the document provides the needed information.