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1. Print the form.
2.
Have your physician or certified nurse
practitioner (CNP) complete and sign.
3. Return
to your Home Provider Specialist
by either:
Mail: Job and
Family Services
222 East
Central Parkway
Cincinnati, Ohio 45202
Attn: Child Care Provider Program
Fax: (513) 946-1102
Be sure to write your Home
Provider Specialist's name on any forms you mail or fax.
Click here for
form
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