KANSAS REPORTABLE DISEASE FORM 2026

1. Click ‘Get Form’ to open the KANSAS REPORTABLE DISEASE FORM in the editor.
2. Begin by entering today's date at the top of the form. Fill in the patient's name, including last, first, and middle names.
3. Provide contact information by entering home/cell phone and work phone numbers. Then, complete the residential address section with city and zip code.
4. Indicate the patient's ethnicity and race by checking all applicable boxes. Specify if they are Hispanic or Latino, and select their race from the options provided.
5. Fill in the patient's sex, date of birth, and age if DOB is unknown. Next, specify the disease name and whether the patient/guardian has been notified.
6. List symptoms experienced by the patient along with their onset date. Indicate if there is an outbreak associated or if institutional residence applies.
7. Complete laboratory information including specimen collection date, test performed, results, and laboratory name. Attach any relevant results as needed.
8. Finally, provide treatment information including date of treatment, status, type/dosage of treatment, and any additional comments before submitting your form.

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