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The Kansas CCL 029 form, a crucial document from the Kansas Department of Health and Environment, outlines a comprehensive framework for medical record-keeping for children in licensed childcare facilities, including the provider's own children. Revised in August 2011 by the Bureau of Child Care and Health Facilities, it serves a pivotal role in ensuring the health, safety, and well-being of children under childcare services in Topeka, Kansas. Parents or guardians are required to fill out detailed information about the child's medical history, immunization records, and consent for emergency medical care, thereby promoting a structured approach to handling health-related matters in childcare settings. Additionally, the form includes sections for recording a child's health assessment completed by a licensed physician or a nurse, further emphasizing the Kansas Department of Health's commitment to maintaining high standards of child health and safety. This documentation process not only streamlines the communication between parents and childcare providers but also ensures that any health concerns are promptly addressed, offering peace of mind to all parties involved. By facilitating the transfer of these records upon a child's transition to another childcare facility, the form highlights a thoughtful system designed to uphold consistent care and monitoring of a child's health across various childcare environments.

Example - Kansas Ccl 029 Form

CCL. 029

Kansas Department of Health and Environment

Rev. 8/2011

Bureau of Child Care and Health Facilities

 

Child Care Licensing Program

 

1000 SW Jackson, Suite 200

 

Topeka, KS 66612-1274

 

Phone (785) 296-1270 Fax (785) 296-0803

 

Website: www.kdheks.gov/kidsnet

MEDI CAL RECORD FOR ALL CHI LDREN I N CHI LD CARE FACI LI TI ES,

I NCLUDI NG PROVI DER’S OWN CHI LDREN

Parents are to complete the Medical Record and the History of I mmunizations for each child in licensed child care facilities. The Medical Record, History of I mmunizations, and Child Health Assessment are transferable w hen the child moves to another licensed child care facility.

Child’s First Day in Child Care

 

 

 

 

Name of Child Care Facilit y

 

 

 

 

 

 

Child’s Name

 

 

 

 

 

Date of Birth

 

 

 

Gender

 

 

 

 

 

First

Last

 

 

 

 

 

 

MM/ DD/ YYYY

 

 

 

M/ F

 

Parent/ Guardian I nformation

 

 

 

 

Parent/ Guardian I nformation

 

 

 

Name

 

 

 

 

 

Name

 

 

 

 

 

 

Home Address

 

 

 

 

Home Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street

City

Zip Code

 

 

 

Street

City

Zip Code

Home Phone Number

 

 

 

 

 

Home Phone Number

 

 

 

 

 

 

Work Address

 

 

 

 

Work Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street

City

Zip Code

 

 

 

Street

City

Zip Code

Work Phone Number

 

 

 

 

 

Work Phone Number

 

 

 

 

 

 

Cell Phone Number

 

 

 

 

 

Cell Phone Number

 

 

 

 

 

 

E-mail Address

 

 

 

 

 

E-mail Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Best way to contact

 

 

 

 

 

Best way to contact

 

 

 

 

 

 

Names and ages of children in family

Persons aut horized to pick up the child or to notify in case of emergency. I nclude name, address, and telephone number. Attach an additional page, if necessary.

Child’s Physician

 

Phone Number

Child’s Dentist

 

 

Phone Number

Hospital Preference (for emergencies)

Has your physician approved the use of any non-prescription medications for your child such as acetaminophen, cough

syrup, or ointments that can be given by the child care provider? No Yes, as follows:

Does your child have any of the following conditions (yes or no) ? I f yes, provide information on Aut horization for Emergency Medical Care form CCL. 010.

 

 

Allergies

 

Frequent sore throats/ colds

 

 

 

 

Ear Aches

 

 

Asthma

 

Speech, Visual, Hearing

 

 

 

 

Diabetes

 

 

Epilepsy/ Seizures

 

Other

 

 

 

 

 

 

I f yes answered to any above, please provide additional information

 

 

 

 

 

 

Have there been major changes at home that might affect your child in care?

 

No

 

Yes, as follows:

Please provide additional information or special instructions that will help t he person caring for your child.

Parent/ Guardian Signature:____ ____________ ___________________ ______ Date:_________ ____

1

History of I mmunizations

Required for all children in child care facilities, including the provider’s ow n children. A Kansas Certificate of I mmunizations ( KCI ) may be substituted for this form and attached to the completed Medical Record.

Child’s Name:

 

Date of Birth:

 

First

Last

 

MM/ DD/ YYYY

Section I . For a recommended schedule of immunizations, refer to the current schedule published by the Advisory Committee on I mmunization Practices ( ACI P) .

Vaccine

 

Record the Month. Day and Year that each Dose of Vaccine w as Received

 

1 st

 

2 nd

3 rd

4 th

5 th

 

6 th

DTaP/ DT/ Td/ Tdap (Diphtheria,

 

 

 

 

 

 

 

 

Tetanus, Pertussis)

 

 

 

 

 

 

 

 

Polio

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MMR (Measles, Mumps, and Rubella

 

 

 

 

 

 

 

 

combined)

 

 

 

 

 

 

 

 

HBV (Hepatitis B Vaccine)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hx of Disease:

 

 

Date of I llness:

Varicella (Chicken Pox)

 

 

 

Physician Signature

 

 

 

 

 

 

 

 

 

 

 

 

HI B (Hemophilus I nfluenzae Type B)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PCV7 (Pneumococcal Conjugate)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HEP A (Hepatitis A)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Rotavirus * * Recommended < 8 mo of

 

 

 

 

 

 

 

 

age; not required

 

 

 

 

 

 

 

 

I nfluenza( Flu) * * Recommended

 

 

 

 

 

 

 

 

annually > 6 mo of age; not required

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section I I .

Complete this section only if your child is exempted from the law requiring immunizations [ K.S.A. 65 - 508( d) ] .

Section I I . Complete Section below only if your child is exempted from law s requiring requiring

The following two options are the ONLY exemptions allowed by law. Please check either ( A) or ( B) below and immunizations [ K.S.A. 65 - 508( d) and K.S.A. 65 - 519( c) ]

complete as required:

( A) Certification from licensed physician stating that immunization w ould endanger child’s life:

Exempt from following immunizations:

 

DTP

 

 

Pertussis Only ____Tetanus ____Polio

MMR

Rubella Only

Hep A

 

Hep B

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hib

 

 

_PCV7 ____Ot her

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Physician’s Signature (required): ________________________________________________Date:_______________

( B) My child is exempt under the law from immunizations. As the Parent or Legal Guardian, I state that I am an adherent of a religious denomination w hose teachings are opposed to immunizations.

Section I I I .

Parent/ Guardian Signature:____ ____________ ___________________ ______ Date:_________ _______

2

CCL. 029a

Rev. 08/2011

Child Health Assessment

The Child Health Assessment form is to be completed and signed by a nurse approved by KDHE to perform Child Health Assessments or a Licensed Physician. I f a Physician Assistant (PA) completes the Child Health Assessment, t he signature of the Licensed Physician authorizing the PA is to be included at the bottom of this form.

A Child Health Assessment, recorded on a KDHE Form or other acceptable Forms mentioned below, is required for all children including children of the provider or staff in Licensed Day Care Homes, Group Day Care Homes, Child Care Centers and Preschools. A Kan-Be-Healthy Assessment Form is a KDHE Form and is acceptable, a Physician Health Assessment Form is acceptable, and a School Health Assessment Form is acceptable for school-age children or youth. The Health Assessment Form used should be attached to the KDHE Medical Record Form (CCL. 029) .

Child’s Name_______ __ ___________________ _____________ Date of Birth_________ __________

First

Last

Health history and medical information pertinent to routine child care and emergencies (describe, if any):

None

Do you see this child for regular health supervision:

Yes No

Allergies to food or medicine ( describe, if any):

None

List current medications (if any):

None

 

Length/ Height: ______ I N/ CM

% I LE_______

Weight: _____ LB/ KB % I LE_______

 

Physical Examination

 

 I f Normal

I f Abnormal - Comments

 

 

 

 

 

 

Head/ Ears/ Eyes/ Nose/ Throat

 

 

 

 

 

 

 

 

 

Teeth

 

 

 

 

 

 

 

 

 

Cardio/ Respiratory

 

 

 

 

 

 

 

 

 

Abdomen/ GI

 

 

 

 

 

 

 

 

 

Genitalia/ Breasts

 

 

 

 

 

 

 

 

 

Extremities/ Joints/ Back/ Chest

 

 

 

 

 

 

 

 

 

Skin/ Lymph Nodes

 

 

 

 

 

 

 

 

 

Neurologic & Developmental

 

 

 

 

 

 

 

 

 

Screening Tests

 

Screening Date

Note Here if Results are Pending or Abnormal

 

 

 

 

 

 

Lead

 

 

 

 

 

 

 

 

 

Anemia (HGB/ HCT)

 

 

 

 

 

 

 

 

 

Urinalysis (UA)

 

 

 

 

 

 

 

 

 

Hearing

 

 

 

Vision

Health Problems or Special Needs, Recommended Treatment/ Medications/ Special Care (Attach additional sheets if necessary)

None

Signature of Licensed Physician or Nurse approved for Child Health Assessments

Date

 

 

 

Print the Name of the I ndividual Signing Above

 

Phone Number

 

 

 

Address

City

Zip Code

 

 

 

3

File Data

Fact Name Description
Form Identification The form is identified as CCL. 029, used by the Kansas Department of Health and Environment, specifically within the Bureau of Child Care and Health Facilities for child care licensing.
Purpose Its primary purpose is to maintain a comprehensive Medical Record for all children in licensed child care facilities, including the provider’s own children, covering medical history, immunizations, and health assessments.
Components The document consists of sections detailing personal and parental information, detailed medical records including a history of immunizations, medical conditions, emergency contacts, and authorization for emergency medical care.
Governing Law It operates under Kansas statutes, specifically K.S.A. 65-508(d) and K.S.A. 65-519(c), which outline requirements and exemptions related to child immunizations in care facilities.
Immunization Exemptions Two exemption options from state-required immunizations are provided within the form: medical risk as certified by a physician, and religious beliefs opposed to immunizations.

Kansas Ccl 029 - Usage Guide

After completing the Kansas CCL. 029 form, it's essential to submit it promptly to the respective child care facility to ensure that all medical and immunization records are up-to-date. This form is crucial for the health and safety of children in care, including the facility's ability to respond effectively in case of an emergency. Make sure to keep a copy for your records and confirm with the child care provider that the form has been received and accepted.

  1. Start by entering the Child's First Day in Child Care, Name of Child Care Facility, Child’s Name (First and Last), Date of Birth (MM/DD/YYYY), and Gender (M/F).
  2. Fill out both sections of Parent/Guardian Information including Name, Home Address (Street, City, Zip Code), Home Phone Number, Work Address (Street, City, Zip Code), Work Phone Number, Cell Phone Number, E-mail Address, and the best way to contact.
  3. List the Names and Ages of Children in the family.
  4. Provide the details of Persons authorized to pick up the child or to notify in case of emergency, including name, address, and telephone number. Attach an additional page if necessary.
  5. Enter the Child’s Physician Phone Number and Child’s Dentist Phone Number.
  6. State the Hospital Preference for emergencies.
  7. Answer whether your physician has approved the use of any non-prescription medications for your child, and if yes, specify which medications.
  8. Check and answer if your child has any of the listed conditions such as Allergies, Frequent sore throats/colds, Ear Aches, etc., and provide additional information if needed.
  9. Indicate whether there have been major changes at home that might affect your child in care and provide details.
  10. Offer any additional information or special instructions that will help the person caring for your child.
  11. Sign and date the form under Parent/Guardian Signature.
  12. For the History of Immunizations, start with the Child’s Name and Date of Birth.
  13. Record the Month, Day, and Year each Dose of Vaccine was Received following the detailed schedule on the form.
  14. Complete the Child Health Assessment section only if exempt from the law requiring immunizations, selecting either exemption reason (A or B) and completing as required.
  15. Sign and date under Parent/Guardian Signature at the end of the immunization section.
  16. The Child Health Assessment form (CCL. 029a) should be completed and signed by a nurse approved by KDHE or a Licensed Physician, including details of health history, allergies, current medications, results from physical examination and screening tests, with recommendations for any special care, and signed by the professional who conducted the assessment.

Make sure all the information provided is accurate and complete before submitting the form to the appropriate child care facility. This information is essential for the safety and well-being of your child and others in the facility. Compliance with these steps ensures that your child receives the best possible care while in the facility.

Get Clarifications on Kansas Ccl 029

What is the purpose of the Kansas CCL 029 form?

The Kansas CCL 029 form serves as a comprehensive medical record for children enrolled in licensed child care facilities, including the child care provider's own children. It documents the child's health history, immunization record, and any medical conditions or allergies that the child care provider needs to be aware of. The form is designed to ensure that the child care facility has all necessary health information to provide safe and appropriate care to each child. This information includes the child's medical history, authorized emergency contacts, and health care providers’ contact details. Additionally, the form includes sections for documenting immunizations and exemptions to immunization requirements, thereby complying with Kansas state laws.

How often does the Kansas CCL 029 need to be updated?

The Kansas CCL 029 form should be updated whenever there is a significant change in a child’s health status, such as a new diagnosis, allergy, or medication. Moreover, it's important to review and update the form annually to ensure that the child care provider has the most current information. Regular updates help in maintaining an accurate record of immunizations as well as any changes in emergency contact information or the child's medical providers. This is crucial for providing the best care and for making informed decisions in emergency situations.

Can the Kansas CCL 029 form be transferred to another child care facility?

Yes, the Kansas CCL 029 form, along with the History of Immunizations and Child Health Assessment, is transferable when a child moves to another licensed child care facility within Kansas. This transferability is designed to streamline the process of moving between facilities, ensuring that children's health records are kept consistent and up to date across care settings. It saves parents and guardians time by not having to complete new forms upon changing facilities and assists in maintaining continuous compliance with Kansas's health documentation requirements for child care facilities.

What are the exemptions for the immunization requirements documented on the Kansas CCL 029 form?

There are two exemptions allowed by Kansas law for the immunization requirements documented on the CCL 029 form: medical and religious exemptions. Medical exemptions require certification from a licensed physician stating that immunization would endanger the child's life, specifying which immunizations are exempt. Religious exemptions are available for children whose parents or legal guardians are adherents of a religious denomination whose teachings are opposed to immunizations. Parents choosing an exemption must complete the relevant section of the CCL 029 form, indicating the nature of the exemption and providing necessary signatures and documentation as required by state law.

Common mistakes

Completing the Kansas CCL 029 form accurately is essential, as it provides vital medical information for children in child care facilities, including immunization history and emergency contact details. However, mistakes can easily occur if not filled out carefully. Let's go over some of the common errors people make when filling out this form:

  1. Not checking the form for completeness: Skipping sections or failing to provide all requested details can cause delays or issues in the child care provider's ability to ensure the child's safety and health requirements.
  2. Forgetting to update emergency contact information: It's crucial to keep the named individuals and their contact information current, ensuring the child care facility can reach someone in an emergency.
  3. Incorrectly listing immunization dates: Providing inaccurate dates for vaccinations can lead to misunderstandings about a child's immunization status, possibly affecting their eligibility for care.
  4. Omitting physician or dentist contact information: Neglecting to include this information can hinder a child care provider's ability to reach out to healthcare professionals in case of a medical emergency.
  5. Not specifying allergies or medical conditions: Failing to detail a child's allergies, medications, or health conditions can put the child at risk for adverse reactions or health issues while in care.
  6. Overlooking the need for physician's signatures for exemptions: For children who are exempt from certain immunizations, a physician's signature is required but often forgotten.
  7. Leaving out details about non-prescription medication approvals: Parents must specify which over-the-counter medications can be administered, including dosages and situations when they can be given.
  8. Ignoring sections regarding changes at home: Major changes in a child's home environment can impact their well-being and behavior in care. Not sharing this information can prevent caregivers from providing the best support.

Avoiding these mistakes can significantly improve the quality of care and safety of children in child care settings. It's about making sure that every detail on the form is filled out thoughtfully and thoroughly.

Here are additional tips to ensure the form is filled out correctly:

  • Review the form with a fine-tooth comb before submitting it. Double-check dates, names, and contact information.
  • Update the form regularly, especially after any major medical changes, or at least annually, to ensure all information remains current.
  • Keep a copy of the completed form for your records. It's helpful to have your own copy to refer back to or in case the form gets misplaced.
  • Communicate any concerns or questions you might have with your child care provider. They can offer guidance or clarification on how to fill out the form correctly.

By paying attention to details and avoiding these common mistakes, parents and guardians can help ensure their children receive appropriate care and attention in child care settings.

Documents used along the form

When completing the Kansas CCL 029 form for medical records in child care facilities, various complementary forms and documents are often needed to ensure comprehensive care and compliance with regulations. Understanding these additional documents can make the process smoother for parents, guardians, and providers.

  • CCL.010 Authorization for Emergency Medical Care Form: This document is essential for outlining the specific measures to be taken in case of a medical emergency. It includes authorization from the parent or guardian for the child care provider to obtain emergency medical care for the child.
  • Kansas Certificate of Immunizations (KCI): A standardized form that documents a child's immunizations. It can be attached to the medical record as proof of vaccinations and is critical for meeting state health requirements.
  • Child Health Assessment: Often filled out by a healthcare provider, this form reviews the child's overall health, including allergies, medications, and any special care needs. It is a thorough examination that complements the medical history provided in the CCL.029 form.
  • Physician Health Assessment Form: Similar to the Child Health Assessment, this document is completed by a child's physician to evaluate the child's health status. It is accepted in various childcare settings, including licensed daycare homes and preschools.
  • Kan-Be-Healthy Assessment Form: A form recognized by the Kansas Department of Health and Environment (KDHE) that provides a detailed health assessment of the child. It is an acceptable document for meeting the health assessment requirements in a child care setting.
  • School Health Assessment Form: For school-age children, this form assesses the child's health to ensure they are fit for school activities. It is recognized as an acceptable form of health assessment in child care and educational settings.

Together, these documents offer a comprehensive overview of a child's health and vaccination status, inform care providers of any special care requirements, and ensure preparedness for emergencies. Their use alongside the Kansas CCL 029 form facilitates a safer and more supportive environment for children in care.

Similar forms

The Kansas CCL 029 form is similar to a variety of other documents used in child care and educational settings, primarily due to its focus on health and safety requirements for children. These similarities exist in the manner they collect health history, immunization records, and emergency contact information, aiming to ensure a safe environment for all participants. For instance:

Immunization Record Forms used in other states often share a strong resemblance with the Kansas CCL 029 form, particularly in the History of Immunizations section. Like the CCL 029 form, these immunization record forms require detailed documentation of vaccinations received by the child, including the dates and types of vaccines. This ensures that all children in a care setting meet state-mandated immunization requirements, safeguarding against the spread of vaccine-preventable diseases. The importance of such documentation can't be overstated, as it directly impacts public health within schools and daycares by promoting herd immunity.

Emergency Medical Authorization Forms found in both school and childcare settings, are another example of documents similar to the Kansas CCL 029 form. These forms generally include sections for parents to detail their child's allergies, chronic conditions, and preferred hospitals, much like the CCL 029 does. Additionally, they incorporate consent sections where parents authorize care providers to make medical decisions in emergencies when they cannot be reached. This parallel between the forms exists because both aim to facilitate swift and informed responses in situations where a child's health or safety is at risk.

Child Health Assessment Forms that are required for entrance into public schools or participation in sports routinely collect information similar to what is found on the CCL 029 form. For example, they often include checklists for physicians to document a child's health status, including any limitations or health concerns that educators or caregivers should be aware of. These forms, like the Kansas CCL 029, play a crucial role in identifying health problems that could affect a child’s ability to participate fully in school activities or require special accommodations, fostering an inclusive environment for all children.

Dos and Don'ts

When filling out the Kansas CCL 029 form, there are key practices to follow for accuracy and compliance. Paying attention to these can help ensure that the process is smooth and effective. Below are curated lists of what you should and shouldn't do when completing the form.

Things You Should Do:

  1. Ensure all information provided is accurate and up-to-date, especially contact information and medical details.

  2. Review the immunization history carefully and ensure it matches the child's medical records, to avoid inaccuracies or missing information.

  3. Sign and date the form where required, as an unsigned form may not be considered valid.

  4. Attach any additional documents or pages if the space provided is not sufficient for detailed responses, especially regarding medical conditions or emergency contacts.

Things You Shouldn't Do:

  • Do not leave any required fields blank; if something does not apply, clearly mark it as "N/A" to indicate it was not overlooked.

  • Avoid using abbreviations or medical jargon that may not be universally understood unless such abbreviations are standard and widely accepted.

  • Do not forget to attach the relevant immunization records or exemption forms, as incomplete documentation can delay processing.

  • Refrain from submitting the form without reviewing it for mistakes or omissions, as errors can complicate or delay acceptance.

Misconceptions

Understanding the Kansas CCL 029 form, which pertains to the medical records for children in child care facilities, involves navigating through some common misconceptions. It's essential to give clear and accurate information to ensure families and child care providers are well-informed about health and safety documentation. Here's a list of nine misconceptions and the truth behind each:

  • Immunization records are only necessary once. Immunization records, alongside the medical record, need to be updated regularly to reflect the most current health status and immunization schedule of the child. These records are crucial, especially when children transition to new child care facilities.
  • The form is only for the child care provider's use. While the form is used by child care providers to ensure compliance with health requirements, it also serves as a comprehensive health record for parents. This includes a history of immunizations and other vital health information that can be used for various purposes outside of child care settings.
  • Only parents can fill out the CCL. 029 form. It's true that parents or guardians are responsible for completing the initial information, including the medical history and authorizations. However, some sections, like the Child Health Assessment, must be completed and signed by a health professional.
  • Every section of the form must be completed for enrollment in child care. While most sections of the form are required, there are parts, such as the immunizations exemption section, that are only filled out under specific circumstances, like religious beliefs or medical reasons that contraindicate vaccinations.
  • Health assessments on the form can be completed by any healthcare professional. The Child Health Assessment must be completed by a nurse approved by the Kansas Department of Health and Environment (KDHE) or a licensed physician. If a Physician Assistant (PA) fills out the form, it must include the authorizing physician’s signature.
  • The form is only valid in the state of Kansas. While the form is specific to Kansas, the information it contains, especially the immunization records and health assessments, is critical and often transferable to child care facilities in other states, albeit sometimes requiring additional documentation.
  • Non-prescription medication approvals are optional. Given the varying health needs of children, obtaining physician approval for the use of non-prescription medications while in child care can be crucial. This ensures the child receives proper care and that providers are authorized to administer needed medication.
  • Allergies and other health conditions are only relevant if they require medication. Documenting allergies and health conditions, regardless of whether medication is needed, is essential. This information helps child care providers to manage potential health situations and to be prepared for emergencies.
  • A new CCL. 029 form must be completed every year. Although regular updates to the health information are required, a new form does not need to be completed annually. Updates should be made when there are changes to the child's health status, immunizations, or when the child transitions to a new care facility.

Correcting these misconceptions ensures that both child care providers and parents understand the importance of accurate and up-to-date health records for the safety and well-being of children in care.

Key takeaways

  • Filling out the Kansas CCL 029 form is required for all children in child care facilities, including the provider’s own children, ensuring that each child’s health information and immunization history are properly documented.
  • The form includes sections for medical records, a detailed history of immunizations, and exemptions to immunization requirements, which must be fully completed by the parents or legal guardians.
  • For immunization exemptions, Kansas law recognizes only medical reasons and religious beliefs. Proof of exemption requires a signed statement either from a licensed physician, for medical exemptions, or a declaration by the parent or guardian for religious exemptions.
  • In addition to the child’s health information, caregivers must provide emergency contact information, the child’s physician and dentist contact details, hospital preference, and any non-prescription medications approved by the physician for use by the child care provider.
  • The Child Health Assessment, part of the CCL. 029a, must be completed and signed by a licensed physician or nurse approved by the KDHE, to perform health assessments. This ensures a professional evaluation of the child’s health, necessary for informing care and emergency procedures.
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