ATHLETE SPORTS MEDICINE PACKET
RETURNING SOPHOMORES, JUNIORS AND SENIORS
Below are all the forms that will be required of each returning
student–athlete for the 2008-2009 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:
-
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.
-
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.
-
Print a hard copy of File # 1
Athlete Insurance /
Insurance Claim Filing / Medical Addendum Forms File
(a total of 6 pages).
-
Print a hard copy of File # 2
HIPAA / Assumption
of Risk / Info Release Forms / General Policies & Procedures Statement /
Training Room Policies / General Policies Forms File
, PAGE 9 ONLY.
-
Make sure the correct signatures are included on pages 3, and 6 of
file # 1 and Page 9 of File # 2. 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 7 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.
2008-2009 Deadlines
Wednesday August 13, 2008---All Fall Sports Paperwork Due (M&W Soccer, W Tennis, Volleyball, M&W Cross Country, M Water Polo and M&W Golf)
Wednesday August 20, 2008---Spring Sports w/ Non Traditional Fall playing Season Paperwork Due (Baseball, Softball M Tennis)
Wednesday August 27, 2008---All Winter Sports Paperwork Due (M&W Basketball and M&W Swimming & Diving)
September 1, 2008---All Spring (non-traditional) Walk-ons (not recruited) Paperwork Due (BASE, SB & MTEN)
Friday September 5, 2008---All Remaining Spring Sports Paperwork Due (M&W Track and Field, W Water Polo)
September 15, 2008---All Winter Walk-ons (not recruited) Paperwork Due (SWIM & MWBB)
Friday January 23, 2009---All
Transfers/Spring Sports Walk-ons Paperwork Due
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 |