Kansas child care licensing requires a health assessment for every enrolled child, including the provider's and staff members' own children, in family child care homes, centers and preschools. This KDHE form records the history, growth measurements, physical exam and screening results the facility keeps on file so caregivers know about allergies, medications and special care needs.
A licensed physician, a physician assistant or a nurse approved to perform health assessments completes and signs the form. It has no parent section; the child care facility keeps the signed form in the child's record.
Download the current version from the source each time; forms change without notice.
Medical Record: Child Health Assessment
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
The form states that the assessment must be conducted not more than 12 months before and no later than 60 calendar days after the child enrolls at the child care facility. The rule applies in family child care homes, child care centers and preschools alike.
Yes. KDHE accepts the assessment recorded on its own form or on another acceptable form: a Kan-Be-Healthy Assessment Form, a Physician Health Assessment Form, or a School Health Assessment Form for school-age children or youth.
The form must be completed and signed by a licensed physician, a physician assistant, or a nurse approved to perform health assessments. The signer also prints their name and adds a phone number and practice address.