If the infant has a medical exemption to sleep in a position other than on their back a licensed physician must provide instruction on an alternate sleeping position. The following shall be included with the medical exemption:
Instructions on how the infant shall be placed to sleep, including sleep position.
Duration the exemption is to be in place
The licensed physician's contact information
Signature of the licensed physician and date of signature
ATTACH REQUIRED DOCUMENTS TO THIS FORM AND MAINTAIN IN THE INFANT'S FILE PURSUANT TO TITLE 22, SECTION 101429(a)(2(c) FOR CHILD CARE CENTERS OR SECTION 102425(c)(2) FOR FAMILY CHILD CARE HOMES.