Okla Corporation (DBA: Okla Kids Child Care) Norma E.

Sanchez-Budhu T/A Okla Corporation 9238 Okla Drive, Fairfax, VA 22031 (703) 978-4204 (norma_e_sanchez@yahoo.com) Virginia Department of Social Services www.dss.virginia.gov

Note to Return to Okla Kids Child Care from the Childs Pediatrician

Childs Name: Childs Birth date / / .

Date when the child was physically examined at the pediatricians office Symptoms and diagnosis found:

Notice that the child does or does not have a contagious illness:

Date the child may return to day care

Guidance for proper care, or any advice for caretakers:

Follow up date (if applicable)

__________________________ Pediatricians signature

___________________________________ Pediatric Offices Stamp