ATHLETE SPORTS MEDICINE PACKET
INCOMING FRESHMEN, TRANSFERS & FIRST TIME ATHLETIC PARTICIPANTS
Welcome to Penn State Behrend Athletics and the Penn State Behrend Sports Medicine Department!
Below are all the forms that will be required of each incoming student–athlete for the 2009-2010 school year. These forms must be completed and returned to the Sports Medicine Department prior to the pre-participation physical examination. The appropriate deadline for each sport is listed below. Failure to complete any or all forms by the deadlines will disqualify you from having a pre-participation physical, and thus exclude you from participation in athletic department sponsored practices and competitions. There will be no exceptions to this policy. If you have questions regarding these forms, you should contact the Sports Medicine Department at either 814-898-6340 or 814-898-7227.
Please use the following as a checklist to complete these forms:
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Please read these forms carefully. Each of these 2
files must be completed and on record with the Sports Medicine
Department (addresses listed below), prior to the appropriate deadline,
in order for you to have a pre-participation physical examination.
-
All signatures requested must be correct and included in order for an
insurance packet to be deemed complete.
-
These forms must be typed. Handwritten Copies of these packets are
unacceptable and thus deemed incomplete.
-
Save each of the following files to your hard drive and then fill each
file out completely and save it again to your hard drive.
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Print a hard copy of File # 1
Athlete Insurance /
Insurance Claim Filing / Medical Addendum Forms File
(a total of 11 pages).
-
Print a hard copy of File # 2
General Policies &
Procedures Statement / Athletic Training Room Policies / General
Policies Form / HIPAA / Assumption of Risk / Info Release Forms
, PAGE 9 ONLY.
-
Make sure the correct signatures are included on pages 3, 10 and 11
of file # 1. The signature on page 3 of file # 1 must be the
insurance policy holder’s signature.
-
Email Saved File # 1 to either Jeff Webster ATC
jxw63@psu.edu or Angela Meserole ATC
amm43@psu.edu
- Mail Hard copy of File # 1 and Page 9 of File # 2 to the address listed below (a total of 12 pages). Please include a copy of your most recent insurance cards.
Penn State Behrend Sports
Medicine
5103 Station Road
Junker Center
Erie, PA 16563-0400
- DO NOT STAPLE the Hard Copy (Paper) Forms
We realize the depth of the information we are asking you to complete.
However, due to more stringent medical privacy acts and our need for more
detailed medical histories for our records, as well as those of our
insurance carrier, we need to constantly update and expand our base of
medical records for all Penn State Behrend student-athletes. We are asking
for your cooperation and patience as we continue to implement these
procedures. Please be aware that all of this information will continue to
be confidential, and will only be used as it pertains to your need for
medical treatment and referral.
2009-2010 Deadlines
Ø Monday August 10, 2009---All Sports Paperwork (recruited) Due for the following teams: M&W Soccer, M&W Tennis, Volleyball, M&W Cross Country, M&W Water Polo, M&W Golf, Baseball, Softball, M&W Basketball, M&W Swimming and M&W Track and Field (indoor and Outdoor)
Ø All Walk-ons (not recruited) Paperwork Due by August 19, 2009 for (MWGOLF, MWSOC, MWXC, MWP, WTEN & VB)
Ø All Spring (non-traditional) Walk-ons (not recruited) Paperwork Due by August 31, 2009 for (BASE, SB & MTEN)
Ø All Winter & Spring Walk-ons (not recruited) Paperwork Due by September 15, 2009 for (SWIM, MWBB, MWTF & WWP)
Ø All 2nd Semester Transfers and Spring SOC/VB Walk-ons (not recruited) Paperwork Due By January 8, 2010
If you have questions regarding these forms, you should contact the Sports
Medicine Department at either 814-898-6340 or 814-898-7227.
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Word document |
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Student Insurance/Medical History HIPAA/Info Release/Policies and Procedures |