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Clinic Authorization Form

To verify service locations and hours, contact Janet Braley at JBraley@KUMC.edu.

Medical Pavilion
2000 Olathe Blvd., Level 1, Suite D
Kansas City, KS 66160
Phone: 913-588-2200
Fax: 913-588-2769
Monday-Friday: 7 a.m.-7 p.m.*
*If you are coming to the clinic for drug testing, you must arrive before 6 p.m.
KU MedWest
7405 Renner Road
Shawnee, KS 66217
Phone: 913-588-2200
Fax: 913-588-8423
Monday-Friday: 7 a.m.-7 p.m.* 
Saturday: 8 a.m.-4 p.m.
*If you are coming to the clinic for drug testing, you must arrive before 6 p.m.
  • New Return
  • Drug Screen
  •      NIDA (DOT) Non-NIDA (Non-DOT)
  •      E-screen
  •      Pre-Placement
  •      Random
  •      Post accident
  •      Probable cause
  • Breath Alcohol
  •      Post accident
  •      Random
  •      Post-Offer
  •      Probable Cause
  • Post-Offer physical
  • DOT physical
  •      New Recertification
  • Periodic physical
  • Return to work exam
  • Agility test
  • Respirator physical
  • Pulmonary function (PFT)
  • Audiogram
  • Hepatitis B
  • TB
  • Neurometrix
  • Other
  • Per employer's telephone instructions
Remarks

Related links

RETAINWORKS
Clinic Services Authorization
Clinic Authorization Form