Forms

Downloadable

Forms & Notices

Before your visit, fill out and print the forms needed to speed up your check-in process.

Privacy Notice

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DOT Physical Form

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DOT Certificate

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Our

Policies

Treatment Priority & Wait Times Policy

Typically, we see patients at K+STAT in the order they sign in. The exception would be patients needing immediate attention due to potentially dangerous conditions. We make every effort to get you in and out as quickly as possible.

We do not see patients younger than 3 months of age.

HIPAA Privacy Policy

The Health Insurance Portability and Accountability Act’s (HIPAA) medical privacy regulations govern the use and release of patients’ personal health information, also known as “protected health information (PHI).” In the event state law is more restrictive than the HIPAA regulations, the more restrictive law will apply.

Under the HIPAA privacy regulations, patients must be informed about how their PHI will be used and given the opportunity to object to or restrict the use or release of their information. Physicians may use and disclose PHI without the patient’s consent for purposes of treatment, payment, and healthcare operations. For a complete copy of our Notice of Privacy go to download patient forms page.

Treatment of Minors Policy

Coming soon…

X-Ray Notice

If an x-ray is needed to make a diagnosis, films will be read by physicians at K+STAT. The x-ray may require an over-read by a radiologist. In these cases, there will be an additional charge from the radiologist.

We have staff available to perform x-rays during most hours of operation.

Lab Notice

The following labs are done in-house: urine, mono, pregnancy, flu, blood sugar, COVID and strep. Certain tests (STI, blood work) will be referred to an outside lab. In these instances, there will be an additional charge from the reference lab.

Insurance

We do not accept insurance for Medicaid, Kancare-Sunflower products, or the active-duty military member. We are happy to see you, but it will be at your own expense.

Contact Us

To contact K+STAT Urgent Care, please call us during regular office hours.