ATHLETE SPORTS MEDICINE PACKET
RETURNING SOPHOMORES, JUNIORS AND SENIORS
Below are all the forms that will be required of each incoming
student–athlete for the upcoming School Year. These forms must be
completely filled out and returned to the Sports Medicine Department
at least one week prior to the pre-participation athletic
physical examination. Failure to complete any or all forms, will
delay your ability to have an athletic department sponsored
pre-participation physical, and thus delay your participation in
athletic department sponsored practices and games. 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:
-
Please read these
forms carefully.
Each of these files must be filled out completely and be on record
with the Sports Medicine Department (addresses listed below) in order
for you to have a pre-participation physical examination.
-
Handwritten Copies of
these packets are unacceptable and thus deemed incomplete.
-
DO NOT STAPLE the Hard Copy
(paper) Forms
-
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.
-
Print a hard copy
(Paper) of File # 1
Athlete Insurance / Insurance Claim Filing / Medical Addendum Forms File (a total of 6 pages)
-
Print a hard copy
(Paper) of File # 2
HIPAA / Assumption of Risk / Info Release Forms / General Policies &
Procedures Statement / Training Room Policies / General Policies Forms
File,
PAGE 9 ONLY.
-
Email Saved File # 1
to either
jxw63@psu.edu or
amm43@psu.edu
- Mail Hard copy (Paper) of File # 1 and Page 9 of File # 2 to the address listed below (a total of 7 pages).
Penn State Behrend Sports Medicine
5103 Station Road
Junker Center
Erie, PA 16563-0400
- Make sure the correct signatures are included on Hard Copy (Paper) pages 3, and 6 of file # 1 and Page 9 of File # 2.
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 institute 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 son/daughter’s need for medical
treatment and referral.
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 Form/Medical Addendum HIPAA/Info Release/Policies and Procedures |