PRA Disclosure StatementThe time required to complete this information collection is estimated to average seventeen (17) minutes per step, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: KDEM, 2800 SW Topeka Boulevard, Attn: Plans, Topeka, KS 66611. |
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HIPAA Notice of Privacy PracticesThe information and notice on the website below describes how medical information (also known as Protected Health Information, or PHI) about you may be used and disclosed, as well as how you can get access to this information. Please review it carefully. You must acknowledge receipt of the notice at the end of the HIPAA document prior to entering data in the Vulnerable Needs Individual System Information Form. |
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