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                "type": "TITLE",
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                },
                "text": "KENTUCKY STATE UNIVERSITY\nStudent Health Services\nConsent Form (student 17 and younger)",
                "reading_order": 0,
                "level": 1
            },
            {
                "page": 1,
                "type": "TITLE",
                "location": {
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                    "b": 480.72
                },
                "text": "(Please Print)",
                "reading_order": 1,
                "level": 2
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 68.16,
                    "t": 463.44,
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                    "b": 350.64
                },
                "text": "I, _____ give consent for _____ to (Parent/Guardian) (Student)\nreceive medical services from Student Health Services, local hospitals\nand/or other medical facilities for sickness or injury.",
                "reading_order": 2
            },
            {
                "page": 1,
                "type": "FIGURE",
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                "text": "",
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                "type": "TEXT",
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                "text": "Parent/Guardian",
                "reading_order": 4
            },
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                "page": 1,
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                "text": "Date",
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