Okla. Stat. tit. 72, § 72-351: Report of veterans who may have been exposed to certain

defoliants or herbicides - Report form.

A. A physician or other qualified health care professional who

has primary responsibility for treating a veteran who believes the

veteran may have been exposed to chemical defoliants or herbicides

or other causative agents, including Agent Orange, while serving in

the Armed Forces of the United States, shall, at the request of the

veteran, submit a report to the Department on a form provided by the

Department. If there is no physician or other qualified health care

professional having primary responsibility for treating the veteran,

the hospital or other medical facility treating the veteran shall,

at the request of the veteran, submit the report to the Department.

B. The form provided by the Department to the physician or

other qualified health care professional or hospital or other

medical facility shall request the following information:

1. Symptoms of the veteran which may be related to exposure to

chemical defoliants or herbicides or other causative agents,

including Agent Orange;

2. Diagnoses of the veteran; and

3. Methods of treatment prescribed.

C. The Department may require the veteran to provide such other

information as determined by the Commissioner.