The KDHE CCL 029 form is the standardized child medical record that Kansas requires for every child enrolled in a licensed child care facility. Parents complete the medical history section, a licensed physician, physician assistant, or approved nurse completes the health assessment, and the finished form goes to the child care provider rather than to any state agency. Kansas Administrative Regulation 28-4-430 gives families up to 60 calendar days after a child’s initial enrollment to get the completed form on file, though most providers want it before or on the first day.1Legal Information Institute. Kansas Administrative Regulations 28-4-430 – Health Practices; Illness and Abuse
Where to Download the Form
The CCL 029 is available on the KDHE Forms and Applications page for child care licensing.2Kansas Department of Health and Environment. Forms and Applications Many centers and family child care homes also hand out blank copies at enrollment, so ask your provider before printing one yourself. A Kansas Certificate of Immunizations (KCI) can substitute for the immunization history portion and be attached to the completed medical record.3Kansas Department of Health and Environment. CCL 029 and 029a Child Medical Record Immunization History and Health Assessment PDF
What Parents Fill Out
The parent or legal guardian completes the medical history section. That covers the child’s legal name, date of birth, known allergies to foods or medications, current medications with dosages and schedules, and any chronic conditions such as asthma or diabetes that the facility will need to manage. Include the primary physician’s name and contact number so staff can reach them in an emergency.
Accuracy here matters more than any other part of the form. Caregivers rely on what you write to respond correctly if your child has an allergic reaction, a seizure, or a medication question. Treat the history as a living document: Kansas regulation requires the facility to review it with you at least once every 12 months, and you should update it any time your child develops a new allergy, starts or stops a medication, or receives a new diagnosis.1Legal Information Institute. Kansas Administrative Regulations 28-4-430 – Health Practices; Illness and Abuse
What the Health Care Provider Fills Out
A licensed physician, physician assistant, or nurse approved to perform health assessments completes the clinical portion of the CCL 029. The assessment can be done no more than 12 months before enrollment, and it must be on file no later than 60 calendar days after your child’s initial enrollment.1Legal Information Institute. Kansas Administrative Regulations 28-4-430 – Health Practices; Illness and Abuse Scheduling a well-child visit a few weeks before your child’s start date fits that window comfortably.
If your child recently had a well-child visit and the exam is still within the 12-month window, you may not need a new appointment. Bring the blank CCL 029 to the provider’s office and ask them to fill it in from the existing visit records. Before you leave, check that the signature, printed name, exam date, and credentials are legible. An incomplete form cannot be counted as on file, and your provider may exclude the child from care until the gaps are fixed.
Children transferring from one Kansas licensed child care facility to another do not need a brand-new health assessment, as long as the previous medical record is available from the prior facility.1Legal Information Institute. Kansas Administrative Regulations 28-4-430 – Health Practices; Illness and Abuse Ask the old provider to forward the file directly. That alone can save you a doctor visit and a co-pay.
Required Immunizations
Kansas requires children in licensed child care to be current on a specific set of vaccines under K.A.R. 28-1-20:
- Diphtheria, tetanus, and pertussis (DTaP)
- Haemophilus influenzae type B (Hib)
- Hepatitis A
- Hepatitis B
- Measles, mumps, and rubella (MMR)
- Pneumococcal disease (PCV)
- Polio
- Varicella (chickenpox)
This list is slightly longer than the K-12 school list because it adds Hib and pneumococcal vaccines, which are specific to younger children in group care.4Legal Information Institute. Kansas Administrative Regulations 28-1-20 – Immunizations; Schools, Child Care The immunization record must be obtained no later than 60 calendar days after initial enrollment and kept with the medical record form.1Legal Information Institute. Kansas Administrative Regulations 28-4-430 – Health Practices; Illness and Abuse
Medical and Religious Exemptions
Kansas allows two exemptions from the child care immunization requirement under K.S.A. 65-508. A medical exemption requires a licensed physician to certify in writing that immunization would endanger the child’s life or health. A religious exemption requires the parent or guardian to sign a written statement that the requirement conflicts with sincerely held religious beliefs; under Kansas law, that term includes non-theistic moral and ethical beliefs held with the strength of traditional religious views.
The facility must grant a religious exemption without questioning the sincerity of the request.5Kansas Legislature. Kansas House Bill 2669 Exemption documentation stays on file with the child’s medical record. One boundary to know: during a disease outbreak, unimmunized children may be temporarily excluded from the facility even with a valid exemption on file.
Turning the Form In
Hand the completed CCL 029 directly to your child care provider. It does not go to KDHE or any other state agency. The facility keeps it on-site in your child’s file, where it must be available for review during licensing inspections. Kansas law requires these records to remain confidential and bars disclosure except as otherwise provided by law or with the consent of the parent or guardian.6Kansas Department of Health and Environment. Kansas Laws and Regulations for Licensing Preschools and Child Care Centers – K.S.A. 65-507
Do a quick check before handing it over: every signature line signed, every date filled, provider credentials legible, immunization dates matching the KCI if you’re attaching one.
What Happens If the Form Is Missing or Late
The licensing consequences for missing records fall on the facility, not on you. KDHE inspectors cite incomplete medical records as violations during licensing reviews, and unresolved violations can trigger civil fines against the facility after notice and a hearing.7Kansas Department of Health and Environment. Kansas Laws and Regulations for Licensing Preschools and Child Care Centers – K.S.A. 65-526 The practical fallout still reaches your child, though: because the provider carries the regulatory risk, expect persistent follow-up on missing paperwork and, if the 60-day deadline passes with no form on file, possible exclusion from care until the record is complete. Getting the CCL 029 done on time keeps your enrollment smooth and your provider out of trouble.