Kansas Department of Health and EnvironmentCCL. 029 Rev. 5/2019Bureau of Family Health Child Care Licensing Program 1000 SW Jackson, Suite 200 Topeka, KS 666121274 Phone (785) 2961270 Fax (785) 5594244 Website:.
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How to use or fill out the Attach An Additional Page, If Necessary online
Filling out the Attach An Additional Page, If Necessary is a crucial part of submitting important medical records for children in child care facilities. This guide will provide you with clear instructions to ensure you complete this section correctly and efficiently.
Follow the steps to fill out the additional page successfully.
- Press the ‘Get Form’ button to access the form online and open it in the editor.
- Begin by entering the name of the child care facility and the child's name, ensuring accuracy in spelling. Include the child's date of birth in the format MM/DD/YYYY.
- Fill in the parent or guardian information completely, providing the name, home address, and phone numbers, including home, work, and cell numbers. Also, indicate the preferred method of contact.
- List the names and ages of other children in the family as well as individuals authorized to pick up the child or be contacted in an emergency situation. Make sure to include their address and phone number.
- Complete the sections regarding the child's physician and dentist by filling in their names and phone numbers. Specify the hospital preference for emergencies.
- Indicate if the child's physician has approved the use of any non-prescription medications by selecting either 'Yes' or 'No.' If 'Yes,' detail any approved medications.
- Answer the questions regarding any medical conditions or allergies. If any conditions or significant changes at home may affect the child in care, provide detailed information in the space provided.
- Include any additional information or special instructions that will assist the caregiver in providing proper care for your child.
- Sign the form to certify the accuracy of the information you've provided and date your signature.
- Review all the entered information for accuracy. Once confirmed, save your changes and choose to download, print, or share the completed form as needed.
Take the next step and complete your documents online for a smooth submission process.
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