Kansas form medical 2026

1. Click ‘Get Form’ to open the Kansas Certificate of Immunizations - Medical Exemption form in the editor.
2. Begin by entering the student's name and birthdate in the designated fields. Ensure accuracy as this information is crucial for identification.
3. Fill in the street address, city, state, and zip code of the student. This helps in maintaining proper records.
4. Provide the parent or guardian's name and telephone number for contact purposes.
5. Indicate the medical exemption reason by checking the appropriate box next to 'Medical exemption due to'.
6. Select all applicable vaccines from the list provided. This includes options like DTaP/DT, Polio, MMR, etc.
7. In the Physician Information section, print and fill out the physician's name, address, city, state, zip code, and telephone number.
8. The physician must certify by signing and providing their medical license number along with the date and state of licensure.

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