KS Certificate of Immunization (KCI) - Form B 2018 free printable template
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KANSAS CERTIFICATE OF IMMUNIZATIONS FORM MEDICAL EXEMPTION Student Name:Birthdate:Street Address: City:State:Zip Code:Parent/Guardian: Telephone: Medical exemption due to For the following vaccine(s):
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How to fill out KS Certificate of Immunization (KCI) - Form B
01
Obtain the KS Certificate of Immunization (KCI) - Form B from your healthcare provider or school.
02
Complete section 1 with the student's personal information, including name, date of birth, and school attended.
03
In section 2, provide information about the parent or guardian, including their name and contact information.
04
In section 3, list all required vaccinations and their dates. Ensure that the vaccines are documented by a healthcare provider.
05
If applicable, include any exemptions in section 4, explaining the reasons for the exemption.
06
Review the completed form for accuracy and completeness.
07
Sign and date the form in the designated area.
08
Submit the completed form to the appropriate school or institution.
Who needs KS Certificate of Immunization (KCI) - Form B?
01
Students enrolling in a Kansas school for the first time.
02
Students transferring from another state.
03
Students entering preschool or kindergarten.
04
Students needing to update their immunization records for compliance with school requirements.
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What is KS Certificate of Immunization (KCI) - Form B?
The KS Certificate of Immunization (KCI) - Form B is a document that provides official proof of immunizations received by a student in the state of Kansas. It is used to verify that students are up to date with required vaccinations.
Who is required to file KS Certificate of Immunization (KCI) - Form B?
Parents or guardians of students enrolling in childcare facilities, schools, or colleges in Kansas are required to file the KS Certificate of Immunization (KCI) - Form B for their children.
How to fill out KS Certificate of Immunization (KCI) - Form B?
To fill out the KS Certificate of Immunization (KCI) - Form B, one needs to enter the student's personal details, including name and date of birth, and provide information about the immunizations received, including dates, types of vaccines, and the health care provider's information.
What is the purpose of KS Certificate of Immunization (KCI) - Form B?
The purpose of the KS Certificate of Immunization (KCI) - Form B is to ensure that students are compliant with vaccination requirements for health and safety reasons, preventing the spread of vaccine-preventable diseases within school and community settings.
What information must be reported on KS Certificate of Immunization (KCI) - Form B?
The KS Certificate of Immunization (KCI) - Form B must report the student's name, date of birth, the specific immunizations received, including the date of each vaccination, and the name and contact information of the healthcare provider who administered the vaccines.
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