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            "text": "Medical History Form",
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            "text": "INSTRUCTIONS AND INFORMATION:",
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                    "bbox": {
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                    "text": "We recommend this form be returned to the address below within 30 days or no later than 14 days prior to enrollment. All pages must be completed.",
                    "marker": "1."
                },
                {
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                    "text": "We recommend this form be completed by all new students and students who have been away from the University for more than 10 months. We also recommend students entering graduate school complete this form.",
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                {
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                    "text": "Information on this form is CONFIDENTIAL, is for Kentucky State University Student Health Services, will not be released without the student's consent, and will not affect admissions status.",
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                {
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                    "text": "Send completed forms to: Office of Admissions",
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            "text": "Kentucky State University"
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            "text": "ASB Suite 312"
        },
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            "bbox": {
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            "text": "400 E. Main St."
        },
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            "text": "Frankfort, KY 40601"
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            "text": "Fax: (502) 597-5814"
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            "text": "IDENTIFICATION",
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                    "text": "ID Number (see acceptance letter): ___",
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            "text": "Rev 2/22/16",
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