Records Request

Developer records request form

Please complete the form below to initiate the process for access.

First name Last name Email Phone

Include area code + phone number. If outside United States, please include country code.

Organization or business name Do you have a business associate agreement with The University of Kansas Health System? Yes No Your Role: I am a developer who represents a partner organization. I am an independent developer of a 3rd-party application. I am an individual developer of a 3rd-party application. Other I certify that the information provided on this form is true to the best of my knowledge. I further understand that any false information provided on this form will result in forfeiture of access to developer access. I agree to adhere to the terms of use established by The University of Kansas Health System.

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Developer records request form