Patient Foster Placement Information

Do providers have patient medical records? To provide appropriate medical care and meet KDHE
, providers must have the patient's past medical history, including but not limited to:
Current health or development concernsCurrent medicationsAny known drug allergiesImmunizationsDate of patient's last physical/Well Child Exam

Do medical treatment facilities have the placement/guardianship papers for this patient on file?
Facilities must have these records in the patient’s chart to meet HIPAA regulations before seeing the patient.

Primary Insurance Information

Additional Insurance Coverage Information (if applicable)

Please have ALL insurance card(s) (or a copy) at ALL visits
Insurance won't pay until ALL Insurances are listed, so Parents Responsible

If the patient does not have insurance coverage for the date services are provided:

Responsible party for payment of services:

All services, with the exception of hospital services, must be paid OR
an acceptable form of payment offered on the Date of Service.

Please note:

  • We do not accept KanCare Sunflower Health Insurance Plan.
  • We WILL accept KanCare Amerigroup, and KanCare United Healthcare Community Plan for a provider who has an open panel.
  • One of our providers must be listed as the Primary Care Provider on the patient’s
    insurance plan. A PCP change form may need to be completed (Consider seeking care
    with PCP listed to maintain continuity of care.)
  • If the patient has commercial insurance coverage, we are UNABLE to see a patient who
    is locked in to another provider, especially under HMO plans.
    (If locked in, it may be
    advisable to seek care with PCP listed.)