disciplinary Forms
The forms on this page were created using Adobe Acrobat. They are best viewed with that software or Acrobat Reader. If your browser does not support this feature, please save the document to your local computer and then open it directly in one of the Acrobat applications. Adobe Acrobat Reader is available at no charge from Adobe (click the Get Adobe Acrobat Reader link below to download the software):
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
- Complaint Form
- Health Care Facility Forms
- Adverse Findings Report
- Closed Claim Report
- Initial Report
- KDHE Quarterly Report
- Attestation Questions
- Professional Liability Claim or Settlement
- Felony or Misdemeanor
- Licensing Agency, State or Government Agency Action, License Denial or Surrender
- Hospital Privileges, Peer Review or Professional Association
- Impairment
- Licensing Agency, State or Governmental Agency Investigation