Forms for Students, Staff, and Parents - Student Health Services - Michigan State University

Forms for Students, Staff, and Parents

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General Forms

• Consent Form for Parents/Guardians of Patients under age 18
• Financial Responsibility Form
• MSU HealthTeam (and Olin) Notice of Privacy Practices
• Feedback Form
  
• Patient Authorization
  
• Worksite Ergonomic Evaluation 

Alcohol, Tobacco, and Other Drugs Education

• E-Chug Survey

Allergy & Immunization

• Allergy History Information Sheet
• Injectable Medications Questionnaire Form
• MSU Immunization Policy for students
• Are You Immune Aware?

Financial Wellness Coaching

• Financial Coaching & Referral Form

HIV Testing and Counseling

• HIV Knowledge Assessment Quiz [pre-test]
• HIV Testing Brochure (for more information)

Psychiatry

• Psychiatry Intake Form
• PHQ-9 (Chinese)
• Self-Care Plan (Chinese)
• Lucas Functional Assessment (Chinese)

SHS Employees

• Labor and Student Payroll Form
• Labor and Student Payroll Form plus Time Conversion Chart
• Overtime/Comp Time Approval Form (for Supervisor)
• Overtime/Comp Time Payroll Form
• Overtime/Comp Time Payroll Form plus Time Conversion Chart
• Payroll Record CTs 2017

Workers Comp

• Authorization to Invoice MSU
• Authorization to Invoice MSU - Employees not in the Lansing Area
• Report of Claimed Occupational Injury or Illness