Graphic Links Menu Graphic Link to Our Mission Graphic Link to The Board Graphic Link to Staff Directory Graphic Link to Contacts Graphic Link to Public Information Graphic Link to Licensure Graphic Link to Disciplinary Procedure Graphic Link to Disciplinary Actions Graphic Link to Statistics Graphic Link to Verifications Graphic Link to Statutes Graphic Link to Rules & Regs Graphic Link to Agency Contacts Graphic Link to Links Graphic Link to Forms Graphic Link to Home

FORMS

The following forms are posted in Adobe Acrobat Reader (PDF) format.

Licensure Forms

    Address Change Request Form  
    Application Packet Request Form  
    Athletic Trainer's Responsible Physician and Protocol Form    
    Credit/Debit Card Payment Authorization Form    
    Foreign School Verification Request Form    
    Institutional License Certification of Employment    
    Name Change Form  
    Notice of Termination of Supervision of a Physician Assistant Form  
    Notification or Termination of Supervision of a Physical Therapist Assistant Form  
     Physician Assistant's Responsible Physician and Drug Prescription Protocol    
    Request for a Duplicate Certificate Form  
    Status Change for the Allied Health  
    Status Change for the Healing Arts  
    Status Change to Military for all Professions  
    USMLE Step 3 Application Form    
    Verification of Kansas License or Registration Form    
    Verification of Non-Kansas License Registration Form  

Licensure RENEWAL Forms

    Occupational Therapy Assistant  
    Occupational Therapy    
    Respiratory Therapists    
    Medical Doctors    

Legal Forms

    Complaint Form  
     

Healthcare Facility Forms

    Report of Adverse Findings Form -
    (Form can be completed and then printed )
 
    (Form is only a printable form)  

Administrative Forms

    Credit/Debit Card Payment Authorization Form  
    Query Order Form  


Forms are posted in Adobe Acrobat Reader (PDF) format.

Graphic Logo for Adobe Acrobat ReaderYou may download a FREE version of the Acrobat Reader here


Our Mission | The Board | Staff Directory | Contacts | Public Information | Licensure Information | Disciplinary Procedure | Board Actions
Statistics | Verifications | Medical Schools | Agency Contacts | Statutes | Rules & Regs | Forms | Links | Database | Site Map | Home

Kansas State Board of Healing Arts
235 S. Topeka Boulevard   -  Topeka, KS 66603-3068
Phone: (785) 296-7413  -  Toll Free: 1-888-886-7205  -  Fax: (785) 296-0852
Disclaimer | Accessibility Policy | State of Kansas Web Site