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CCL 010 Rev. 3/2017 Kansas Department of Health and Environment Bureau of Family Health 1000 SW Jackson Suite 200 Topeka KS 66612-1274 Child Care Program 785 296 -1270 Fax 785 559-4244 Website www. Kdheks. gov/kidsnet AUTHORIZATION FOR EMERGENCY MEDICAL CARE Written permission for emergency medical treatment must be on file at the facility. MM/DD/YYYY Signature of Parent or Guardian Date Signed Witness to Parent s or Guardian s signature if required by the local hospital or clinic....
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