Medical Assessment Form and Dental Assessment Form

The Medical Assessment Form was approved by OMB on October 26, 2023, as part of the Medical Assessment Form and Dental Assessment Form information collection. The purpose of the Medical Assessment Form is to collect standardized health information on unaccompanied children during evaluations with generalist medical providers, pediatricians, and other medical specialty providers. The following two Administration for Children and Families (ACF) Office of Refugee Resettlement (ORR) information collections capture health data on children in ORR care: • Medical Assessment Form and Dental Assessment Form • Mental Health Assessment Form and Public Health Investigation Form: Active TB, and Public Health Investigation Form: Non-TB Illness. ACF has implemented changes to update gender collected data to denote sex as a biological variable in current approved information collection requests to comply with recent presidential directives.

The latest form for Medical Assessment Form and Dental Assessment Form expires 2026-10-31 and can be found here.

Medical Assessment Form - Reporting Time for Pediatricians, General

Federal Enterprise Architecture: Community and Social Services - Social Services

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.