Ksbha form 2026

1. Click ‘Get Form’ to open the ksbha form in the editor.
2. Begin by selecting the appropriate agency receiving the report. Check the box next to Kansas Board of Healing Arts, Kansas Board of Nursing, or any other relevant agency.
3. Indicate whether you are submitting the report as an individual or a facility. Fill in your name, telephone number, address, and email if you are an individual. If a facility, provide the facility name and CCN#.
4. Complete the incident identification section by entering the Incident Report Number (if applicable), date of incident, medical record number, patient name, date of birth, and location of incident.
5. List any licensees involved in the incident along with their details. Describe the incident thoroughly in the provided space or attach a separate sheet if necessary.
6. Select the type of incident from the options provided and ensure all required fields are filled before submitting your report.

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