KS Certificate of Immunization (KCI) 2019-2025 free printable template
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KANSAS CERTIFICATE OF IMMUNIZATIONS (PCI) This record is part of the student's permanent record and shall be transferred from one school to another as defined in Section 726262 (d) of the Kansas School
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How to fill out KS Certificate of Immunization (KCI)
01
Obtain the KS Certificate of Immunization form from your healthcare provider or the Kansas Department of Health and Environment website.
02
Fill in personal information such as your name, date of birth, and contact information.
03
List all vaccinations you have received, including the dates for each immunization.
04
Ensure to include required immunizations such as DTaP, MMR, polio, and others specified by state laws.
05
Have a healthcare provider sign and date the certificate to verify the accuracy of the information.
06
Submit the completed KS Certificate of Immunization to your school or childcare facility as required.
Who needs KS Certificate of Immunization (KCI)?
01
Children attending school or daycare in Kansas.
02
Individuals participating in certain public events that require proof of immunization.
03
Students transferring from out of state to Kansas schools.
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What is KS Certificate of Immunization (KCI)?
The KS Certificate of Immunization (KCI) is an official document that records a person's vaccination status, including details of immunizations received in order to attend school or certain childcare facilities in Kansas.
Who is required to file KS Certificate of Immunization (KCI)?
Parents or guardians of children entering school or childcare facilities in Kansas are required to file the KS Certificate of Immunization (KCI) to ensure compliance with state immunization laws.
How to fill out KS Certificate of Immunization (KCI)?
To fill out the KS Certificate of Immunization (KCI), individuals need to provide information such as the child's name, date of birth, vaccination history, and the dates each vaccination was administered, along with the signature of a healthcare provider.
What is the purpose of KS Certificate of Immunization (KCI)?
The purpose of the KS Certificate of Immunization (KCI) is to verify that children have received the required vaccinations to protect their health and the health of others in the community, as mandated by Kansas law.
What information must be reported on KS Certificate of Immunization (KCI)?
The KS Certificate of Immunization (KCI) must include the child’s name, date of birth, a list of vaccines administered, the dates those vaccines were given, and the signature or stamp of the healthcare provider administering the vaccines.
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