Ccl 009 Template

Guidelines on Utilizing Ccl 009

Before beginning the process to fill out the CCL 009 form, it is important to understand the purpose and requirements surrounding it. This form is a crucial step for individuals over the age of 16 who are involved in the regular care of children in the state of Kansas, including family foster homes. It ensures that these individuals have undergone a health assessment verifying they do not have any physical or mental conditions that would interfere with the safe care of children. The form must be completed accurately and submitted according to the instructions provided by the Kansas Department for Aging and Disability Services.

1. Start by gathering all necessary personal information and any medical records that may be relevant to the health assessment.
2. Print your name and the name of the child care facility where you work exactly as it appears on the license in the fields provided at the top of the form.
3. Fill in the license number, street address, city, zip code, and county of the child care facility.
4. Select the right type of child care facility from the list of options provided on the form by marking the appropriate box.
5. Print your full name (first, middle, last) and date of birth in the spaces provided under "Name of Provider/Staff."
6. Go through the list of health-related questions, checking "Yes" or "No" for each. If you answer "Yes" to any questions, make sure to provide an explanation in the space allowed.
7. If you are listing any chronic conditions or other health concerns, specify these in the designated area, providing as much detail as necessary for clarity.
8. The next section of the form must be completed by a licensed physician or a nurse trained to perform health assessments. You will need to schedule an appointment with a healthcare provider for this portion of the assessment.
9. After the health assessment is complete, the healthcare provider will review your responses and examine you. They will then select and sign one of the two statements indicating whether or not they found evidence of illness that would interfere with your ability to care for children.
10. Record the results of your Tuberculosis (TB) test on the form, specifying the date the test was administered. Attach any additional documentation as required. The healthcare provider or local health department must sign this section.
11. Once the form is completely filled out, review it to ensure all information is accurate and complete. Any incomplete or inaccurate information can result in processing delays.
12. Submit the completed form to the Kansas Department for Aging and Disability Services, following the submission guidelines provided by the department. Ensure you keep a copy for your records.submit>

After submitting the CCL 009 form, your role is to wait for the department to process the information. Processing times can vary. It's essential during this waiting period to maintain any records of correspondence and to be available for any follow-up questions from the Kansas Department for Aging and Disability Services. Once processed, you will receive notification regarding the status of your health assessment, including any next steps required to comply with Kansas state regulations for child care providers.

What is the purpose of the CCL 009 form?

The CCL 009 form is a mandatory document used to assess the health status of individuals 16 years of age and older who are involved in the care of children. This includes regular care providers and those living in a Family Foster Home as stipulated by Kansas regulations. The assessment ensures that the individuals do not have any physical or mental conditions that could interfere with the safety, health, or welfare of the children they are caring for.

Who is required to complete the CCL 009 health assessment?

Every person over the age of 16 regularly caring for children, particularly in settings such as licensed day care homes, licensed group day care homes, and Family Foster Homes, must undergo this health assessment. However, temporary substitutes in these settings are not required to complete the form.

Can a Physician Assistant (PA) conduct the health assessment?

Yes, a Physician Assistant (PA) is authorized to complete the health assessment, but it must include the signature of the licensed physician who authorized the PA to conduct the assessment.

Are substitute forms allowed in place of the CCL 009?

No, substitute forms are not accepted for the health assessment. The Kansas Department for Aging and Disability Services requires that the health assessment be recorded specifically on the CCL 009 form provided by the department.

What types of conditions or treatments must be disclosed on the CCL 009 form?

Individuals must disclose if they see a physician regularly for any condition, are on any regular medication, have had any surgeries in the past three years, possess any handicapping conditions that might interfere with child care, or have any chronic illnesses such as heart disease, diabetes, mental illness, etc.

What happens if evidence of physical or mental illness is found?

If the licensed physician or nurse trained to perform health assessments finds evidence of physical or mental illness that could conflict with the individual’s ability to care for children, this must be noted on the form. Depending on the nature of the findings, it may impact the individual’s ability to work in a childcare setting.

Is a tuberculosis (TB) test required for the health assessment?

Yes, part of the health assessment includes the results of a TB test or a negative chest x-ray. The form specifies that a repeat test is not needed unless there is an exposure to TB or symptoms develop.

How often must the CCL 009 health assessment be completed?

The form does not specify the frequency of the health assessment, suggesting it is a one-time requirement unless there are changes in the individual’s health status. However, it is advisable to check with the Kansas Department for Aging and Disability Services for any updates or changes to this requirement.

Where can I find more information or obtain the CCL 009 form?

Additional information and copies of the CCL 009 form can be obtained from the Kansas Department for Aging and Disability Services website at www.kdads.ks.gov. You can also contact them directly via phone or fax for further assistance.

When individuals fill out the CCL 009 form, which is a Certificate of Health Assessment for persons 16 years of age or older in Kansas, involved in childcare, several common errors can occur. These mistakes not only delay the process but can also impact compliance with the Kansas Department for Aging and Disability Services requirements. Understanding these errors can help in avoiding them and ensuring the form is completed accurately and efficiently.

1. Not using the KDHE form: The form specifically states that substitute forms are not accepted. Some individuals, however, might overlook this detail and submit alternative documents they believe are equivalent. This can lead to automatic rejection, as the Health Assessment must be recorded on the provided KDHE form.

2. Incomplete sections: Each section of the form, both for the provider/staff and the licensed physician or nurse, needs to be filled out comprehensively. Often, entries might be partially completed or left blank, especially in sections requiring detailed information such as medication names, specifics of chronic illnesses, or surgery details within the last three years.

3. Failure to detail medical conditions: The form asks whether the applicant sees a physician regularly for any health condition, takes any medication regularly, has had any surgery in the past three years, has any handicapping conditions, or has chronic illness conditions. A common mistake is checking "yes" but not providing an explanation. This can leave the assessment incomplete, as explanations are crucial for a thorough evaluation.

4. Omitting the date of the TB test or the signature of the person who read the test: For the health assessment to be valid, a negative tuberculin test or a negative chest x-ray and its date must be included. Moreover, the test must be read by a licensed physician or nurse, whose signature is mandatory on the form. These details are frequently overlooked, causing unnecessary delays.

5. Signature oversight: At the bottom of the form, there is a requirement for the signature of the Licensed Physician or Nurse trained to perform health assessments, following their review and examination. Sometimes, this section is left unsigned or is signed but not dated. This oversight can invalidate the entire submission, requiring the applicant to resubmit, thereby prolonging the process unnecessarily.

By understanding and addressing these common mistakes before submission, individuals can ensure that their Certificate of Health Assessment will be compliant, accurate, and processed in a timely manner. This not only expedites one's ability to legally work in childcare settings but also contributes to the overall safety and well-being of children in care.

Completing the Certificate of Health Assessment, known as the CCL 009 form, is a critical step for individuals over 16 years of age who are either living in a family foster home or regularly caring for children in various settings as outlined by the Kansas Department for Aging and Disability Services. This document ensures that caregivers or residents in these environments meet health standards that promote safety and wellness for children. However, the CCL 009 form is not the only document necessary during this process. Several other forms and documents are often used alongside the CCL 009 form to ensure comprehensive compliance and health assurance.

• Child Abuse and Neglect Central Registry Release of Information Form: This document is crucial for verifying that an individual does not have a history of child abuse or neglect. It helps in ensuring the safety of the care environment.
• Emergency Medical Consent Form: This form authorizes the provision of emergency medical treatment for children under someone’s care, should it become necessary and in cases where direct parental consent cannot immediately be obtained.
• Fingerprint-Based Criminal History Records Check: This is a mandatory check to ensure that caregivers or residents of a foster home do not have a criminal record that would pose a risk to children.
• Training Documentation Form: Proof of completed required training sessions or certifications related to childcare or foster care provisions. This form documents the skills and knowledge individuals have acquired to safely care for children.
• Medication Administration Log: For facilities or homes where medication is administered, this log tracks the dosage, frequency, and type of medication given, ensuring proper health care practices are followed.
• Fire Safety Inspection Checklist: An essential form that details the safety measures and fire readiness of the care facility or home, ensuring it meets local fire code standards.
• Child Health Record: This form documents the health history, vaccinations, and any special medical needs of the children under care, ensuring personalized care aligned with health requirements.

Together with the CCL 009 form, these documents form a comprehensive suite ensuring regulatory compliance and the safety and well-being of children in care settings. Each of these forms serves a unique purpose, from legal compliance to health monitoring, contributing to a safe and nurturing environment for childcare. When used in conjunction, they provide a solid framework for the responsible management of child care facilities and foster homes, reflecting the commitment of caregivers and administrators to the highest standards of child safety and care.

The CCL 009 form, a Certificate of Health Assessment for persons 16 years of age or older involved in the care of children, shares similarities with other health-related certification forms. These comparisons highlight the overlapping requirements and purposes among forms utilized within various regulatory or compliance frameworks.

Form I-693, Report of Medical Examination and Vaccination Record

Similar to the CCL 009 form, the Form I-693 serves a specific regulatory purpose, this time for U.S. immigration applicants. Both forms require a medical professional's assessment and signature, verifying the individual's health status. Specifically, they include checks on chronic illnesses, vaccination statuses, and the presence of conditions that might affect the person's ability to perform his or her duties or pose a public health concern. While the CCL 009 form is used to ensure the health of those caring for children, Form I-693 is aimed at protecting public health by assessing immigrants' fitness to enter the United States. The core similarity lies in their function to screen health to safeguard the well-being of a specific population group.

OSHA's Respirator Medical Evaluation Questionnaire

This document is another example where health assessments are crucial. OSHA requires the Respirator Medical Evaluation Questionnaire to be completed to ensure workers can safely use respirators on the job. Like the CCL 009 form, it entails a health assessment but focuses specifically on respiratory health and the physical capability to wear a respirator under working conditions. Both forms necessitate a medical professional's judgment on whether a person's health condition may impact their capacity to fulfill their roles without posing a risk to themselves or others. Despite the difference in specific focus, the underlying principle of assessing health to mitigate risks in a regulated context aligns them closely.

Pre-Participation Physical Evaluation for Athletes

Often required for students or individuals engaging in competitive sports, this evaluation shares the CCL 009 form's objective of assuring that individuals are physically and mentally fit for their roles. Both involve a thorough check-up that looks at various health aspects, including chronic conditions, medication use, and any physical or mental health issues that could impede the participant's ability to safely engage in their expected duties or activities. While the focus of the Pre-Participation Physical Evaluation is on athletic readiness, and the CCL 009 targets those caring for children, each form plays a crucial role in preemptively identifying health concerns that could warrant interventions or limitations for safety.

When filling out the CCL 009 form, which is a Certificate of Health Assessment for individuals 16 years of age or older involved in childcare in Kansas, it's crucial to pay attention to detail and provide accurate information. This form must be completed by a licensed physician or a nurse trained to perform health assessments, which is essential for those regularly caring for children. Here are important do's and don'ts to keep in mind:

• Do ensure that you're using the most current version of the CCL 009 form by checking the Kansas Department for Aging and Disability Services website.
• Do print all information clearly and legibly to avoid any misunderstandings or processing delays.
• Do complete every section of the form. If a question does not apply to you, indicate this with "N/A" (not applicable) instead of leaving it blank.
• Do answer all questions truthfully. Providing false information can have serious consequences.
• Do list any medications you are taking regularly, as well as any health conditions, surgeries within the past three years, or handicapping conditions that could interfere with the care of children.
• Do provide detailed explanations for any "Yes" responses to health questions, including the nature of the condition, treatment, and how it is being managed.
• Do ensure that the health assessment is completed by a licensed physician or a nurse trained to perform health assessments. A Physician Assistant (PA) may also complete the assessment with the signature of the licensing physician.
• Do attach the results of the TB test to the form if it's not recorded directly on the document.
• Do not use substitute forms. The KDHE requires that the health assessment be recorded on the CCL 009 form specifically.
• Do not forget to have the healthcare provider sign and date the form, confirming they have reviewed the information and conducted the assessment.

By following these guidelines, individuals can ensure their CCL 009 form is filled out correctly and processed smoothly, meeting the requirements for those involved in childcare settings in Kansas.

There are numerous misconceptions surrounding the Certificate of Health Assessment (CCL 009 form) required for individuals related to childcare facilities in Kansas. Let's clarify some of these misunderstandings to ensure everyone has accurate information.

• All caregivers must complete the CCL 009 form regardless of their role.

  This is not true. The requirement specifically applies to individuals over 16 years old regularly caring for children. Temporary substitutes in licensed daycare homes or licensed group daycare homes are exempt.

• The health assessment can be completed on any medical form.

  Actually, the assessment must be recorded on the Kansas Department for Aging and Disability Services (KDADS) form. Substitute forms are not accepted, underlining the importance of using the specified CCL 009 form.

• Only licensed physicians can complete the assessment.

  Contrary to this belief, a nurse trained to perform health assessments or a Physician Assistant (PA) — with the authorization of a licensed physician — can also complete the form.

• The form is only applicable to those working in daycare settings.

  This misunderstanding overlooks the form's broader requirement. Individuals over 16 residing in a family foster home must also complete the health assessment, expanding its applicability beyond daycare settings.

• A health assessment is a one-time requirement.

  The form does not specify a validity period for the assessment. However, situations may warrant updated assessments, such as experiencing new health conditions, to ensure continued capability in providing care.

• The CCL 009 form is a measure of professional qualification.

  This form primarily assesses health capability to safely care for children, not professional childcare qualifications. Its main concern is with physical and mental health rather than professional skills or experience.

• Tuberculosis (TB) testing is optional.

  Results or evidence of a negative TB test or chest x-ray are required parts of the health assessment. This requirement underscores the form’s concern with communicable diseases that could impact the health and safety of children in care.

• Mental health conditions automatically disqualify an individual.

  The decisive factor is whether a physical or mental illness would conflict with the ability to care for children. The detection of a mental health condition doesn’t automatically disqualify an individual but is considered in context.

• Personal physicians can't review the completed form.

  Although the form needs to be completed by a designated health professional, nothing prevents individuals from discussing the findings or obtaining a second opinion from their personal physician.

• The form is only applicable to new employees.

  This is incorrect. The form applies to all eligible individuals over 16 years of age involved in the specified care settings, regardless of whether they are new or current residents or staff members. It's about ongoing health capability, not just initial suitability for a role.

Dispelling these misconceptions is vital to ensure compliance and the overall aim of the CCL 009 form: to protect the health, safety, and welfare of children in care settings. Accurate information supports this goal by guiding individuals and facilities through the process correctly.

Filling out and using the CCL 009 form, a Certificate of Health Assessment for persons 16 years of age or older, involves a series of steps and requirements that are crucial for individuals regularly caring for children in Kansas. Understanding these key takeaways can help ensure compliance with the Kansas Department for Aging and Disability Services regulations.

• Scope of Requirement: The form mandates a health assessment for any person over 16 years old who regularly cares for children in various settings, including licensed day care and family foster homes. However, it explicitly states that temporary substitutes are not required to undergo this health assessment.
• Authorized Health Professionals: The assessment must be completed by either a licensed physician or a nurse trained to perform health assessments. Importantly, a Physician Assistant (PA) can also conduct the health assessment but must include the signature of the authorizing licensed physician.
• Non-Acceptance of Substitute Forms: The Kansas Department for Aging and Disability Services requires that the health assessment be documented specifically on the CCL 009 form. Submissions on any alternative forms will not be accepted, underscoring the importance of using the correct paperwork.
• Comprehensive Health Inquiry: The form includes a range of questions addressing the individual’s health, including regular physician visits, medication intake, past surgeries, any conditions that might interfere with childcare, and chronic illnesses. These questions aim to evaluate the individual's physical and mental health in relation to childcare capabilities.
• Tuberculosis Testing: A negative tuberculosis (TB) test result or chest x-ray is required as part of the health assessment, with the form specifying that repeat testing is not necessary unless there is exposure or symptoms. This requirement highlights the importance of protecting children in care settings from communicable diseases.

Completing the CCL 009 form accurately and adhering to its specifications ensures not only regulatory compliance but also enhances the safety and well-being of children under care. It is crucial for anyone involved in childcare in Kansas to familiarize themselves with these requirements to provide a safe and healthy environment for children.