The Child Health Assessment form is to be completed and signed by a nurse approved to perform health assessments, a licensed physician, or physician's assistant (PA).
Transfer: The Medical Record is transferable when the child moves to another licensed child care facility.
Immunizations: Required for all children in child care facilities, including the provider's own children.
KCI: A Kansas Certificate of Immunizations (KCI) may be substituted for this form and attached to the completed Medical Record.
Health assessment: The health assessment shall be conducted not more than 12 months before and no later than 60 calendar days after enrollment.
| Question | Answer |
|---|---|
| Form Name | Form CCL 029 |
| Form Length | 3 pages |
| Fillable? | Yes |
| Fillable fields | 150 |
| Avg. time to fill out | 25 min |
| Edition | Rev 07/2024 |
| Issuing agency | Kansas Department of Health and Environment |
| Matches the agency's file | Yes, checked October 2, 2026 |
| Other names | CCL 029, CCL 029a, CCL029, CCL.029a, Medical Record, Child Health Assessment |
| Official source | Form CCL 029 (Rev 07/2024), Kansas Department of Health and Environment |
Kansas Form Ccl 029 isn’t the one you’re looking for?