State law requires health forms signed by a physician or nurse practitioner as well as proof of up to date immunizations for participation in daycare, preschool, school, and athletics at the high school level.  Many other organizations have health form requirements as well.  Many of these forms are detailed and require parent to fill in a significant portion before the physician can sign the form so bringing it to your appointment with the correct portions completed will save time in the office.  Forms done at the time of a well visit are done without charge.  If a form is requested outside of a well visit, there is a charge and the parent must show identification when picking it up (see Identity Theft Protection).  See the bottom of this page for our Health Form Policies.

Kansas State High School Sports Participation Form:  To participate in sports at the high school level, Kansas law requires a physical be done after May 1st and before the start of the season.  We require that the first page MUST be completed by parent or student before the provider can sign the form!  Click here to download the High School Pre-Participation Health Form.

• We will also need records of any immunizations received outside of our office to complete this form.  You can obtain copies of records from other providers with this form.

Childcare Forms:  This form is used for all licensed daycares, preschools, and state supported camps.  To download a copy of the Kansas Child Care form, click here.  Families should fill in the first page, we can provide a vaccine statement and the third page.

• To complete a daycare form, we will need records of any immunizations received outside of our office.  You can obtain copies of records from other providers with this form.

Scout Forms:  For Boy Scout forms, click here.  For Girl Scout forms, click here.  You can search for "health form" to find the proper form you need.

• We will also need records of any immunizations received outside of our office.  You can obtain copies of records from other providers with this form.

Adoption Forms:  Families considering adoption must have health forms on all current family members.  Please speak with your adoption lawyer about forms required for your family.

FMLA Form:  Please contact your Human Resource department if you require paperwork for leave of absence from work due to an ill child.  If your company uses the FMLA governmental forms, you can obtain them from your employer or from this link.  Please note that this form requires significant time to complete (20 minutes is estimated, as noted at the bottom of the form) and we do charge for this form.

Food Allergy Form:  If your child has a severe food allergy, it is recommended that the school or daycare have a form documenting this allergy and giving instructions on what to do.  This form is found on our Forms & Policies page, under related documents, or can be given in our office.

Kansas Asthma Action Plan:  School children in Kansas with asthma will be required to have this form on file in the school nurse's office.  You can find it under "related documents" on our Forms & Policies page.

School Physical Forms:  Our office stocks Kansas state required forms for school entry.  Be sure to ask for one when your child has a well visit.  Any sport form is separate, see that section above.

• We will also need records of any immunizations received outside of our office.  You can obtain copies of records from other providers with this form.

Health Form Policies

It is the goal of Pediatric Partners to complete Health Forms as quickly as possible - with your cooperation.  We would like you to be aware of the following policies:

1.           Blank forms will not be accepted.  Forms will only be accepted for completion if the patient’s name and other information has been completed.  In some cases we may not be able to complete or certify a form if parents have not completed their parts of the forms prior to form submission.

2.           Turnaround time for form completion is usually fewer than 5 business days.  While every effort will be made to complete forms as quickly as possible, parents should realize that at certain times of the year we may receive hundreds of health forms in one week, and remember that each of these has to be carefully reviewed by a physician before it is released.  Parents are strongly advised not to wait until the last moment to look at the paperwork they have received from the program their child is scheduled to attend.

3.          Forms will be held at our office for parents to pick up.  Because of Health Insurance Portability and Accountability Act (HIPAA) regulations, forms will be released to parents and legal guardians only.  We are prohibited to fax or mail medical information to non-medical facilities.  We cannot be responsible for delays or losses in the mail.

4.           Forms are completed for those whose accounts are in good standing.  Delinquent accounts must be brought current before forms will be completed.  Forms must be paid for before they are released.

5.           Many forms require the information to be based on an examination completed within 12 months of the date the form is completed.  Please do not ask us to violate the intent of the form.

6.           Forms are completed on the basis of examinations conducted by physicians in this medical group.  Examinations performed by “check-up centers” will not be cosigned by our office, nor will we complete any forms based in whole or in part on any information provided by such centers or any other provider.

7.           There is no charge for Women, Infants and Children (WIC) forms.

8.           The minimum charge for review or completion of a form is $10 per form.  The charge for the Family Medical Leave Act (FMLA) form is $25.  Charges vary with the duration of physician involvement and time.  The front office staff does not have the authority to alter, reduce, change, or eliminate charges.

9.           Insurance companies do not reimburse for form completion, and we do not bill insurance for completing any form.

10.       Kansas State law requires sports physicals to be completed after May 1^st and before the beginning of the sport season.  Please consider this when scheduling your child’s well visit, as most insurance plans will only cover one well visit per exam year.