This record is part of the student's permanent record and shall be transferred from one school to another as defined in Section 72-6262 (d) of the Kansas School Immunization Law (amended 1994-2026

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This record is part of the student's permanent record and shall be transferred from one school to another as defined in Section 72-6262 (d) of the Kansas School Immunization Law (amended 1994 Preview on Page 1

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How to Use or Fill Out the Kansas Certificate of Immunizations (KCI)

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  1. Click 'Get Form' to open it in the editor.
  2. Begin by entering the student's name in the designated field at the top of the form.
  3. Fill in the county and ethnicity fields as required.
  4. Select the sex of the student by checking either 'MALE' or 'FEMALE'.
  5. Input the birthdate in MM/DD/YYYY format.
  6. Record each vaccine dose received by filling out the corresponding columns for each vaccine listed, ensuring to note any invalid doses as indicated.
  7. If additional doses are added, initial next to those doses and provide your signature below.
  8. Complete the documentation section by having a physician or authorized representative sign and date it.
  9. Finally, ensure that all information is accurate before saving or exporting your completed form.

Start using our platform today to easily fill out and manage your immunization records for free!

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