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Parental Waiver/Refusal of Services


Parents/Guardians have the right to refuse health services for their children; NOCAC Child Development must obtain written documentation of the refusal.



  1. Children may not receive the following health/developmental services without advanced parent authorization.
    1. Developmental and Behavioral Screenings
    2. Dental Service
    3. Lead Screening
    4. Hemoglobin Screening
    5. Immunizations 
    6. Vision Screening
    7. Hearing Screening
    8. Fluoride Treatment
    9. Mental Health Observation from outside agencies
    10. Release of Information
  2. NOCAC Staff will explain all health/developmental services to the family at the first home visit and ensure that the family fully understands all the benefits of each service. If parent/guardian refuses services, staff must contact the Content Area Manager at the Central Office for further guidance before asking the parent/guardian to sign a Waiver of Service Form.
  3. The child’s parent/guardian must complete and sign a Waiver of Service form to document services were refused.  Staff will indicate on bottom of form that they have educated the parents in regards to the service they are refusing and sign their name where indicated.
  4. The Center Manager or designee will scan and email the Waiver of Service form to the Administrative Assistant at the Central Office.
    1. The Administrative Assistant will enter the individual record and entered into ChildPlus.
    2. The Administrative Assistant will route the email to the appropriate Service Area Manager.
    3. The Center Manager or designee will file the form in the child’s center file.
  5. Once the refusal is signed, NOCAC staff will follow-up at a later date with the family to see if there has been a change or they need assistance. Efforts will be documented in ChildPlus under the Family Services tab.
  6. As Mandated Reporters, NOCAC Staff will file a Child Abuse/Neglect Incident Form if the family repeatedly refuses services and the child’s health/well being is suffering because of lack of treatment
    1. Example: NOCAC staff has removed all barriers (transportation, payment, etc) to getting a child to a follow up dentist appointment to remove abscessed teeth and the family refuses services. The lack of service causes the child pain and difficulty with eating.
    2. For example: NOCAC screenings indicates a child needs to be referred to the LEA for further evaluation due to speech and hearing concerns. The family agrees to the referral but continually misses appointments and does not follow through even though NOCAC staff has offered transportation to and from appointments.


Forms and Additional Guidance:

This policy complies with the following

Head Start Program Performance Standard:    1302.41(a) & (b)
ODJFS Child Care Manual:    
CACFP Regulation:    
Caring for Our Children:    
Other Sources:    


Effective Date:   8/7/17 Reviewed Date:   6/8/22
Approved By Policy Council:   8/7/17 Revision Approved By Policy Council:    
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