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CCL 010 Rev. 3/2017Kansas Department of Health and EnvironmentBureau of Family Health 1000 SW Jackson, Suite 200 Topeka, KS 666121274 Child Care Program: (785) 296 1270 Fax: (785) 5594244 Website:

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How to fill out kdhe emergency medical release

01

Obtain a copy of the KDHE Emergency Medical Release form.

02

Begin by entering the personal information of the individual for whom the release is being filled out.

03

Provide contact information for the emergency contact person.

04

Specify any specific medical conditions or allergies that need to be addressed in case of an emergency.

05

Indicate any specific medications that the individual is currently taking.

06

Provide information about the individual's primary care physician or healthcare provider.

07

Sign and date the form to indicate consent and agreement with the information provided.

08

Make copies of the completed form for your records and distribute as necessary.

Who needs kdhe emergency medical release?

01

The KDHE Emergency Medical Release form is typically needed for individuals who have known medical conditions or allergies that may require emergency medical attention. It is often used for children with special healthcare needs, individuals with chronic health conditions, and those who require regular medication administration.

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What is kdhe emergency medical release?

The KDHE Emergency Medical Release is a legal document that allows emergency medical personnel to provide care and treatment to individuals who are unable to give consent due to medical reasons or emergencies.

Who is required to file kdhe emergency medical release?

Typically, individuals responsible for the care of minors or individuals with disabilities are required to file a KDHE Emergency Medical Release to ensure that emergency services can act on their behalf if needed.

How to fill out kdhe emergency medical release?

To fill out the KDHE Emergency Medical Release, provide the required personal information, including the individual's name, date of birth, emergency contact details, and any relevant medical history or allergies, then sign and date the document.

What is the purpose of kdhe emergency medical release?

The purpose of the KDHE Emergency Medical Release is to grant permission for medical personnel to administer emergency care in situations where standard consent cannot be obtained.

What information must be reported on kdhe emergency medical release?

The KDHE Emergency Medical Release must report the individual's personal information, including their name, date of birth, medical history, allergies, and emergency contact information.

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