Page 29 - VT Student Handbook-Rev 6.12.19_Neat

Murray State College
Veterinary Technology
Student Handbook

From Here… Go Anywhere.

HEALTH STATUS RELEASE STATEMENT

Release Date: _______________

Murray State College Veterinary Technology
One Murray Campus
Tishomingo, OK 73460

Dear Veterinary Technology Program Director:

______________________________________________ is under my care for the following
conditions:
__________________________________________________________________

__________________________________________________________________

 I have examined and assessed the above individual and do certify that he/she is able to
attend/return to class and perform ALL classroom and clinical activities in a manner that
will not harm the student nor compromise their safety or the safety of others.

 I have reviewed the Essential Job Requirements and Technical Standards for the
Veterinary Technicians (Murray State College Veterinary Technology Student Handbook
Pages 4 & 5) to aid my assessment of the student.

Licensed Health Care Provider:

Signature: _________________________________________ Date: _____________

Name / Title: ____________________________________________________________
(Please type or print)
Address: ____________________________________________________________

____________________________________________________________
Telephone: ____________________________________________________________

For further information, contact Debbie Reed, RVT 580-387-7521 or Laura Sandmann, RVT 580-
387-7522 – Co-Directors of the Veterinary Technology Program.

Murray State College  One Murray Campus  Tishomingo, OK 73460  580-387-7000  Fax 580-371-9844 
www.mscok.edu

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