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 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 11
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 12 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/Medical History HIPAA/Info Release/Policies and Procedures |