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Ccl 029 2026
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- Click ‘Get Form’ to open the ccl 029 in the editor.
- Begin by entering the child's name and date of birth in the designated fields. Ensure accuracy as this information is crucial for identification.
- Fill out the Parent/Guardian Information section, including names, addresses, phone numbers, and email addresses. This ensures that caregivers can contact you easily.
- List any allergies or medical conditions your child may have. If applicable, provide additional details on the Authorization for Emergency Medical Care form CCL. 010.
- Complete the History of Immunizations section by recording each vaccine received along with dates. If using a Kansas Certificate of Immunizations (KCI), attach it to this form.
- Sign and date the form at the bottom to confirm that all information provided is accurate and complete.
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Related links
The Health Assessment Form used should be attached to the KDHE Medical Record Form (CCL. 029). Childs Name. First. Last. Date of Birth. Health history andRead more
CCL. 029. Curtis State Office Building. Rev. 07/2024. Kansas Department of Health and Environment. 1000 SW Jackson, Suite 200. Topeka, KS 66612-1274. Phone: 785Read more