KDHE FORMS

There are 4 forms required by KDHE. These forms need to be completed and onsite before a child attends preschool. If you attended last year and your information is the same, you only need to complete the AUTHORIZATION FOR EMERGENCY MEDICAL CARE (it is date specific to each school year). 

1. MEDICAL RECORD (you complete)

2. IMMUNIZATION HISTORY (you can fill in the form or get a copy from your health provider instead)

3. HEALTH ASSESSMENT (completed by health provider; sometimes they can complete it based on a recent appointment)

4. AUTHORIZATION FOR EMERGENCY MEDICAL CARE (completed by you. Our license number is 21910)

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