KDHE Kansas Open Records Act Request Form

Requestor Details ( indicates required field):

First Name * Required * Invalid Format	Last Name * Required * Invalid Format	Business Name
Street Address Line 1 * Required
Street Address Line 2
City Abbyville Abilene Ada Admire Agenda Agra Alamota Albert Alden Alexander Allen Alma Almena Alta Vista Altamont Alton Altoona Americus Ames Andale Andover Angola Antelope Anthony Antonino Arcadia Argonia Arkansas City Arlington Arma Arnold Ashland Ashton Assaria Atchison Athol Atlanta Attica Atwood Auburn Augusta Aurora Austin Axtell Badger Baileyville Baldwin Baldwin City Barber Barnard Barnes Barnesville Bartlett Basehor Bassett Bavaria Baxter Springs Bazine Beattie Beaumont Beeler Bel Aire Bellaire Belle Plaine Belleville Belmont Beloit Belpre Belvidere Belvue Bendena Benedict Bennington Bentley Benton Bern Berryton Beulah Beverly Big Bow Big Elk Bird City Bison Blaine Bloom Blue Mound Blue Rapids Bluff City Bogue Bonner Springs Brazilton Bremen Brewster Bronson Brookville Brownell Bucklin Bucyrus Buffalo Buffville Buhler Bunker Hill Burden Burdett Burdick Burlingame Burlington Burns Burr Oak Burrton Bushong Bushton Buxton Byers Caldwell Cambridge Caney Canton Capaldo Carbondale Carlton Carlyle Carmean Carona Cassoday Catharine Cato Cawker City Cedar Cedar Point Cedar Vale Centerville Centralia Centropolis Chanute Chapman Chase Chautauqua Cheney Cherokee Cherryvale Chetopa Cimarron Circleville Claflin Clay Center Clayton Clearview City Clearwater Clements Clifton Climax Clyde Coalvale Coats Cockerill Codell Coffeyville Colby Coldwater Collyer Colony Columbus Colwich Comotara Concordia Conway Conway Springs Coolidge Copeland Corbin Corning Corwin Cottonwood Falls Council Grove Countryside Courtland Coyville Crawford Crestline Croweburg Cuba Cullison Culver Cummings Cunningham Curranville Damar Danville De Soto Dearing Deerfield Delavan Delia Delphos Denison Dennis Densmore Denton Derby Devon Dexter Dighton Dillons Dodge City Dorrance Douglass Dover Downs Dresden Drywood Duluth Dundee Dunlap Duquoin Durand Durham Dwight Earlton Eastborough Easton Edgerton Edison Edmond Edna Edson Edwardsville Effingham El Dorado Elbing Elk City Elk Falls Elkhart Ellinwood Ellis Ellsworth Elmdale Elsmore Elwood Emmett Emporia Englewood Ensign Enterprise Erie Esbon Eskridge Eudora Eureka Everest Fairview Fairway Fall River Falun Farlington Fellsburg Florence Fontana Ford Formoso Fort Dodge Fort Leavenworth Fort Riley Fort Scott Fostoria Fowler Frankfort Franklin Fredonia Freeport Friend Frontenac Fulton Galatia Galena Galesburg Galva Garden City Garden Plain Gardner Garfield Garland Garnett Gas Gaylord Gem Geneseo Geuda Springs GEUDA SPRINGS Girard Glade Glasco Glen Elder Goddard Goessel Goff Goodland Gorham Gove Grainfield Grandview Plaza Grantville Great Bend Greeley Green Green Bush Greenbush Greenleaf Greensburg Greenwich Grenola Gridley Grinnell Gross Guilford Gypsum Haddam Hallowell Halstead Hamilton Hanover Hanston Harding Hardtner Harlan Harper Hartford Harveyville Haskell Havana Haven Havensville Haviland Hays Haysville Hazelton Healy Heizer Hepler Herington Herndon Hesston Hewins Hiattville Hiawatha Highland Hilford Hill City Hillsboro Hillsdale Hoisington Holcomb Hollenberg Holton Holyrood Home Hope Horton Howard Hoxie Hoyt Hudson Hugoton Humboldt Hunnewell Hunter Huron Hutch Hutchinson Independence Industry Ingalls Inman Iola Ionia Isabel Iuka Jamestown Jennings Jetmore Jewell Johnson Johnson City Junction City Kalvesta Kanopolis Kanorado Kansas City Kechi Kelly Kendall Kensington Kincaid Kingman Kingsdown Kinsley Kiowa Kirwin Kismet La Crosse La Cygne La Harpe Labette Lafontaine Lake City Lake of the Forest Lake Quivira Lakin Lamont Lancaster Lane Langdon Lansing Larned Latham Laurence Lawrence Lawton Le Roy Leavenworth Leawood Lebanon Lebo Lecompton Lehigh Lenexa Lenora Leon Leona Leonardville Leoti Levant Lewis Liberal Liberty Liebenthal Lillis Lincoln Lincolnville Lindsborg Linn Linn Valley Linwood Little River Logan Long Island Longford Longton Lorraine Lost Springs Louisburg Lowell Lucas Ludell Luray Lyndon Lyons Macksville Madison Mahaska Maize Manchester Manhattan Mankato Manter Mantey Maple City Maple Hill Mapleton Marienthal Marion Marquette Marysville Matfield Green Mayetta Mayfield McCracken McCune McDonald McFarland McLouth McPherson Meade Medicine Lodge Medora Melrose Melvern Menlo Mentor Meriden Merriam Milan Milford Milton Miltonvale Mineral Minneapolis Minneola Mission Mission Hills Mission Woods Modoc Moline Monmouth Montezuma Monument Moran Morehead Morganville Morland Morrill Morrowville Moscow Mound City Mound Valley Moundridge Mount Hope Mulberry Mullinville Mulvane Munden Munjor Murdock Muscotah Narka Nashville Natoma Navarre Neal Nekoma Neodesha Neosho Falls Neosho Rapids Ness City Netawaka Neutral New Albany New Almelo New Cambria New Century New Salem New Strawn Newton Nickerson Nicodemus Niotaze Norcatur North Newton North Wichita Norton Nortonville Norway Norwich Oakhill Oaklawn Oakley Oatville Oberlin Odin Offerle Ogallah Ogden Oketo Olathe Olmitz Olpe Olsburg Onaga Oneida Opolis Osage City Osawatomie Osborne Oskaloosa Oswego Otis Ottawa Overbrook Overland Overland Park Oxford Ozawkie Palco Palmer Paola Paradise Park Park City Parker Parsons Partridge Pauline Pawnee Rock Paxico Peabody Peck Penalosa Penokee Perry Peru Petrolia Pfeifer Phillipsburg Piedmont Pierceville Piqua Pittsburg Plains Plainville Planeview Pleasanton Plevna Pomona Porterville Portis Potter Potwin Powhattan Prairie View Prairie Village Pratt Prescott Preston Pretty Prairie Princeton Protection Quaker Quenemo Quinter Quivira Radium Radley Rago Ramona Randall Randolph Ransom Rantoul Raymond Reading Redfield Reece Republic Reserve Rexford Rice Richfield Richmond Riley Ringo Riverdale Riverton Robinson Rock Roeland Park Rolla Roper Rosalia Rose Rose Hill Rosedale Roseland Rossville Roxbury Rozel Rush Center Russell Russell Springs Sabetha Saint Francis Saint George Saint John Saint Marys Saint Paul Salina Satanta Savonburg Sawyer Scammon Scandia Schoenchen Schulte Scott City Scottsville Scranton Sedan Sedgwick Selden Selkirk Seneca Severance Severy Seward Sharon Sharon Springs Shawnee Shawnee Mission Sherwin Shields Sieboldt Silver Lake Silverdale Simpson Sims Skidmore Smith Center Smolan Soldier Solomon South Haven South Hutchinson Spearville Spivey Spring Grove Spring Hill Stafford Stanley Stark Sterling Stilwell Stippville Stockton Strauss Strong City Studley Stuttgart Sublette Summerfield Sun City Susank Sycamore Sylvan Grove Sylvia Syracuse Talmage Tampa Tecumseh Tescott Thayer Timken Tipton Tonganoxie Topeka Toronto Towanda Trading Post Treece Tribune Trousdale Troy Turon Tyro Udall Ulysses Uniontown Utica Valley Center Valley Falls Vassar Vermillion Vernon Victoria Viola Virgil Vliets Wa Keeney Wakarusa Wakefield Waldo Waldron Walker Wallace Walnut Walton Wamego Washington Waterville Wathena Waverly Webber Weir Welda Wellington Wells Wellsville Weskan West Mineral Westfall Westmoreland Westphalia Westwood Westwood Hills Wetmore Wheaton Wheeler White City White Cloud Whitewater Whiting Wichita Williamsburg Willis Wilmore Wilsey Wilson Winchester Windom Winfield Winona Woodbine Woodston Wright Xenia Yates Center Yoder Zenda Zimmerdale Zurich * Required * Invalid Format	State ALASKA ALABAMA ARKANSAS ARIZONA CALIFORNIA COLORADO CONNECTICUT DISTRICT OF COLUMBIA DELAWARE FLORIDA GEORGIA (US) HAWAII IOWA IDAHO ILLINOIS INDIANA KANSAS KENTUCKY LOUISIANA MASSACHUSETTS MARYLAND MAINE MICHIGAN MINNESOTA MISSOURI MISSISSIPPI MONTANA NORTH CAROLINA NORTH DAKOTA NEBRASKA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEVADA NEW YORK OHIO OKLAHOMA OREGON PENNSYLVANIA PUERTO RICO RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VIRGINIA U.S. VIRGIN ISLANDS VERMONT WASHINGTON WISCONSIN WEST VIRGINIA WYOMING * Required * Invalid Format	Zip Code * Required * Invalid Format
Phone Number * Required * Invalid Format	Email * Required * Invalid Format

Description of Records Requested :

Please provide a description of the records you would like to inspect or have produced. Please indicate the type of record you are seeking, the title or name of the document, dates, document numbers, facility or location of the subject property. Specificity in a request will assist in speeding up the search and potentially reduce the fees for the request. You may upload an attachment if necessary.

If your request concerns an environmental site or facility, please submit as much of the following information as possible: the site or facility name, identification number, and the precise location (address, latitude/longitude, or legal description). This information can usually be found using the KDHE Environmental Interest Finder (KEIF) website at https://maps.kdhe.state.ks.us/keif/.

Description

Please check the appropriate Division that this request should be routed to. If you are uncertain which Division is most appropriate or if more than one applies, please select "KORA Officer”.

Select Division KORA Officer Office of the Secretary Division of Environment Division of Public Health Division of Health Care Finance Medicaid Operation Division of Health Care Finance Medicaid Director * Required

File(s) To Include (Optional):

Please upload any relevant documents to your request. (docx,doc,pdf,msg)

You have a compatible browser and may drag your files into the grey area above to attach them.

Desired File Format :

Select Format

Fees : Please note KDHE assesses fees for staff time, copies, shipping, and materials necessary to provide the records. KDHE may require advanced payment for these services. KDHE will contact you if the amount will exceed the authorized amount indicated below.

I hereby authorize KDHE to fulfill the above request and bill me for any fees, provided the fee amount does not exceed

Prohibited Uses : K.S.A. 45-230 prohibits the use of names and addresses derived from public records for certain commercial purposes. Violation of this law can result in a civil penalty not to exceed $500 for each violation.

Before submitting your request, please ensure that all information provided is correct. Requests with incomplete or incorrect contact information may not be processed.

By checking the "I agree" checkbox below, requester does not intend to, and will not, use any list of names or addresses contained in or derived from the records or information for the purpose of selling or offering for sale any property or service to any person listed or to any person who resides at any address listed, or sell, give or otherwise make available to any person any list of names or addresses contained in or derived from the records or information for the purpose of allowing that person to sell or offer for sale any property or service to any person listed or to any person who resides at any address listed.

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