Well Child Check or Kan Be Healthy
Hello! Please upload a scan or pictures of the client's most recent physical. Be sure it is dated within the last 365 days. If the client has a Kansas Medicaid (also called KanCare) plan the physical must be on an official KanBeHealthy (KBH) form. If you do not have a copy of the physical or KBH ask the client's provider to fax it directly to us at 620-206-2514.
Client's Name
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First Name
Last Name
Client's Date of Birth
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Month
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Day
Year
Date
Physical or KBH
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