Instructions
Provider Medical Statement
(JFS 01280)

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