In addition to the new patient form, please fill out foster information below – HIPAA protected. You can also use the printable PDF.
Health Records
To provide appropriate medical care and meet KDHE requirements, please present or sign the release for the patient’s past medical history, including but not limited to:
– Current health or development concerns,
– Current medications
– Any unknown drug allergies
– Immunizations
– Date of patient’s last physical/well child check
Please note: if a foster child has commercial insurance, we may not be able to see her/him, especially under HMO plans. If locked in to another provider, it may be advisable to seek care with the PCP listed with the HMO.