School Health Resources/Forms

• School Nurse Contract Letter
• School Nurse Sample Contract
• ACIP Recommended Childhood Immunization Schedule
• Sports Physical Forms
• CLIA User Fee Schedule (.pdf)
• Certification of Health Form for School Personnel (.pdf)
• Certificate of Waiver Tests (.pdf)
• Kansas Certificate of Immunization (KCI) (.pdf)
• Kansas Certificate of Immunizations - Form B Medical Exemption (.pdf)
• KBH/Child Health Assessment Form (option for CHASE) (.pdf)
• CLIA (Clinical Laboratory Improvement Amendments) Regulations relating to schools (.pdf)
• Mandatory Blood Lead Screening Questionaire - 6 mos & 72 mos. (.pdf)

For further information, contact:
- Child and School Health Consultant = (785) 296-7433
Kansas Department of Health & Environment