Forms noted as "Fillable" have fields that can be directly typed into on the computer, and the data can be saved and sent along with the form. If your computer does not display these correctly, or if you prefer to print the forms out and write or type in the information, non-fillable versions have been provided for your convenience.

• Affidavit of Custodian of Records
• Online Complaint Form
• Complaint Form (PDF)
• Health Care Facility Forms
  • Adverse Findings Report Form
  • Closed Claim Report Form
• Initial Report
  • Initial Report Form Instructions
  • Initial Report Form
• KDHE Quarterly Report Form
• Attestation Questions
  1. Professional Liability Claim or Settlement Questionnaire
     
  2. Felony or Misdemeanor Questionnaire
  3. Licensing Agency, State or Government Agency Action, License Denial or Surrender Questionnaire
     
  4. Hospital Privileges, Peer Review or Professional Association Questionnaire
  5. Impairment Questionnaire
  6. Licensing Agency, State or Governmental Agency Investigation Questionnaire

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