Forms & Brochures

Medical records FAX 785.532.3425

Asthma action plan PDF file icon
Consent for treatment PDF file icon
Follow-up health care brochure PDF file icon
Food record instructions
Food record forms PDF file icon
Help for disordered eatingPDF file icon
Lafene services brochure PDF file icon
Lowdown on Lafene [html] PDF file icon

FAQ about services

Medical history PDF file icon

The Medical (Health) history form should be completed by the student prior to the student receiving services. It is often easier (and highly recommended) to have this form on file at Lafene before the student is injured or ill. Return the completed form to Lafene Health Center: Attention - H.I.M. (Health Information Management department).

Meningococcal vaccination documentation PDF file icon
Notice of privacy practices [html] PDF file icon
Patient safetyPDF file icon
Presentation request
Records release for disclosure of protected health information PDF file icon
Student employment application PDF file icon

Travel Clinic BrochurePDF file icon

Travel clinic formPDF file icon



Disclaimer:

Users of the Lafene Health Center web site acknowledge their role and responsibility in seeking health care. Health information is provided on this web site as a reference, and is not intended to replace a visit to your doctor or other health care provider. Lafene Health Center is not responsible for information on web sites other than our own. The mention of a particular product or service does not constitute a recommendation or endorsement unless indicated. KSU students, for health care, see your Lafene healthcare provider. Medical care is not provided using e-mail.