Forms and Policies

*Note: many forms on this page will require Adobe Reader in order to review.

General Forms

• ADD/ADHD Patient Authorization for Disclosure of Health Information

• Financial Responsibility Form

• Minor Consent Form for Parents/Guardians of Patients Under Age 18

• MSU HealthTeam Notice of Privacy Practices

• Patient Authorization for Disclosure of Health Information

• Telehealth Consent Form

Allergy and Immunization

• Allergy History Information Sheet

• Injectable Medications Questionnaire Form

HIV Testing and Counseling

• HIV Knowledge Assessment Quiz (pre-test form)

• HIV Testing Brochure

Psychiatry

• PHQ-9 (Chinese)

• Self-care Plan (Chinese)

• Lucas Functional Assessment (Chinese)

Workers Comp

• Authorization to Invoice MSU

• Authorization to Invoice MSU – Employees not in the Lansing Area

• Report of Claimed Occupational Injury or Illness