Kansas Child Health Assessment Form (CCL-029a): Deadlines, Exemptions, and Cost

To complete the Kansas Child Health Assessment form, a parent fills in the child’s medical history, a licensed physician, physician assistant, or KDHE-certified nurse performs a physical exam within twelve months of enrollment and signs the clinical section, and the parent then delivers the signed form to the child’s school before admission or to the licensed childcare facility within 60 days of enrollment. Kansas requires it for every child up to age nine entering a Kansas school for the first time and for every child under ten enrolling in licensed child care.

Who Has to Submit One

Two separate rules create the requirement.

Under K.S.A. 72-6267, every pupil up to the age of nine who has not previously enrolled in any Kansas school must present health assessment results to the school board before admission. That covers kindergartners, first-time enrollees, and children transferring from out of state who are under nine.¹
Under K.A.R. 28-4-117, every child under ten enrolled in a licensed child care facility must have a completed medical record on file that includes the health assessment. Children under sixteen who live in a child care facility are also covered.²

If your child is entering both school and a before- or after-school program, one assessment satisfies both as long as it was done within twelve months and a copy reaches each place.

Where to Get the Form

The Kansas Department of Health and Environment publishes the child medical record and health assessment form (CCL 029 / 029a) as a downloadable PDF on its website. You can also pick up a paper copy from your child’s school office, a local health department, or a licensed childcare facility. Some school districts mail the form to incoming families along with other enrollment materials.

For school entry, K.S.A. 72-6267 says the state health secretary “shall not prescribe a form on which the results of health assessments are reported.”¹ Most schools accept the KDHE form or a comparable record from a provider. If your pediatrician uses an in-house exam template, check with the school office first that it will be accepted.

Who Can Perform the Exam

The clinical portion must be completed and signed by a licensed physician, a physician assistant, or a nurse who has completed KDHE training and certification to perform health assessments.² Not every nurse qualifies; the nurse must hold the specific KDHE approval. If you’re booking with a clinic rather than a named provider, confirm the person doing the exam has the right credentials.

The exam must have taken place within twelve months before the child’s enrollment date. Anything older will not satisfy the requirement, and the school or facility will send you back for a new one.¹ Schedule no earlier than twelve months out, and leave lead time. Late-summer pediatric appointments fill up fast in Kansas.

What Goes on the Form

The parent or guardian completes the top portion: the child’s name, date of birth, and medical history. Be thorough. Note any chronic conditions, allergies, medications, past surgeries, and hospitalizations. The provider uses that history to guide the exam, and gaps often lead to a follow-up visit that delays your paperwork.

The provider records height, weight, blood pressure, and the results of vision and hearing screenings, checks for developmental concerns, and notes whether the child is cleared for school or childcare activities. The form also includes space for immunization dates, which the provider fills in from your child’s vaccination records.

Submission Deadlines

The deadlines differ depending on whether your child is entering a school or a childcare facility.

School Entry

The default rule under K.S.A. 72-6267 is that the child presents the assessment results before admission and attendance. The statute offers a practical alternative: a parent can submit a signed written statement that the assessment “will be scheduled and completed within 90 days after admission to school.”¹ That 90-day window lets your child start classes while you finalize the paperwork, which helps when you’ve just moved to Kansas and haven’t established care with a local provider.

Childcare Entry

For licensed child care facilities, K.A.R. 28-4-117 gives families 60 calendar days after the child’s initial enrollment to have the completed assessment on file.² The same 60-day window applies to immunization records.

How to Turn It In

Most schools and childcare facilities accept a hard copy handed to the front office or a school nurse. Some districts now let parents upload a scanned copy through an online enrollment portal. Keep a copy for yourself; forms get misplaced, and a backup saves you from repeating the process. After the school or facility receives the form, a nurse or health official reviews it for completeness and files it in the child’s permanent health record.

Alternatives and Exemptions

Kansas provides two alternatives for school entry under K.S.A. 72-6267(c):

A religious exemption. A parent or guardian signs a written statement that the child is an adherent of a religious denomination whose teachings oppose health assessments. The statement must be in writing and kept on file with the school.¹
A 90-day completion statement. A parent or guardian signs a written statement that the assessment will be scheduled and completed within 90 days after admission. This isn’t an exemption from the assessment; it’s a timing accommodation.¹

Immunization exemptions are a separate matter under different statutes. A religious exemption from the health assessment does not automatically exempt your child from immunization requirements, and vice versa. If you need both, submit separate written statements for each.³

If You Miss the Deadline

A school board can exclude a child from attendance if the health assessment (or a qualifying alternative) hasn’t been provided. Before that, the school must send the parent or guardian written notice stating the reason for the exclusion, that the child will remain excluded until the requirement is met, and that the parent has the right to request a hearing. School boards must also send a copy of their health assessment policy to all enrolling families subject to the requirement before each school year.¹ The fastest fix is completing the assessment and handing the form to the school; there’s no penalty beyond the missed days.

For childcare, consequences are handled through KDHE licensing enforcement rather than a formal exclusion hearing. A facility without completed medical records on file inside the 60-day window risks a compliance finding during its next licensing inspection.²

Cost

Under the Affordable Care Act, most health plans cover well-child visits and preventive screenings at no out-of-pocket cost when you use an in-network provider.⁴ A standard well-child visit satisfies the Kansas assessment requirement, so if your child is due for an annual checkup, you can combine the two.

Without insurance, a basic pediatric physical typically runs about $30 to $40 out of pocket, though prices vary by clinic. Some Kansas communities offer free or reduced-cost school physicals through seasonal events; the University of Kansas Health System, for example, has partnered with local school districts to provide free physicals at one-day clinics before the school year.⁵ Local health departments and federally qualified health centers also offer sliding-scale fees. Call your county health department before paying full price at a private clinic.

1
Kansas Office of Revisor of Statutes. Kansas Code 72-6267 – Health Assessments; Definitions; Requirements, Alternatives; Duties of School Boards
2
Legal Information Institute. Kansas Admin Regs 28-4-117 – Health Care Requirements for Children Under 16 Years of Age and Recordkeeping
3
Kansas Legislative Research Department. Vaccine Requirements in K-12 Schools
4
HealthCare.gov. Preventive Care Benefits for Children
5
The University of Kansas Health System. 1-Day Event for Free School Sports Physicals