Pre-Participation Physicals & Forms

All NEW athletes are required to:

• 1) Complete, sign and provide any additional information as required by the forms on Jump Forward. If you do not have a Jump Forward login, you will be provided with one this summer. All forms will need to be reviewed by a staff athletic trainer PRIOR to clearance for participation. Athletes will be cleared based on this review by the staff athletic trainer and/or team physician(s). These are the formes that will need to be completed on Jump Forward:
  1. New Athlete Heath Screening Form 2012
  2. General Med Physical Exam
  3. Orthopedic Evaluation
  4. Insurance Questionnaire 2012
  5. Explanation of Insurance
  6. Authorization for Treatment (if under 18)
  7. Authorization for Treatment
  8. Informed Consent & Assumption of Risk 2010
  9. Authorization for the Release of Medical Information
  10. Assumption of Risk
  11. Sickle Cell Trait Form
• 2) Have a comprehensive physical exam prior to participation in athletic activities which includes:
  • General Medical Exam
  • Orthopedic Exam
  • Lab Work
• 3) Provide verification of their Sickle Cell Trait Status.

General Medical Exam
Please print these two forms and complete the New Athlete Health Screening Form prior to your general medical exam. These forms are also available on Jump Forward.

• New Athlete Health Screening Form
• General Med Physical Exam

Athletes have three options to complete their general medical exam:

1. Schedule an appointment with team physicians during the summer (free & recommended by medical staff). Appointments for general medical physicals with our team physicians can be made anytime during the summer by calling Dr. Drum's office at (562) 795-6406. Tell them you are an LBSU athlete when making the appointment
2. See their own physician, at athlete's expense. Please print the following forms and bring them to your general medical exam to be completed, signed and stamped by a physician. All forms will need to be provided to the athletic training staff at your sport's physical date. They are also available on Jump Forward:
3. Attend the physical date for your sport listed below

Physical Dates:

Orthopedic Exam
Orthopedic exams will take place during the scheduled physical time for each team listed above and will be completed by our own physicians. There are NO EXCEPTIONS

Lab Work
Each athlete will have blood work performed:

• Complete Blood Count (CBC)
• Uninanalysis (UA)

Testing can be completed at the Student Health Center on campus at no charge, or may be complete by a person physician if preferred at your own expense (a copy of results must be submitted with other physical paperwork). Please contact the athletic training department if you wish to have testing completed at the Student Health Center so that we may provide you with the blood work form.

The NCAA mandates that ALL student-athletes have knowledge of their sickle cell trait status prior to participation in any sport activity beginning August 1, 2010. This includes events, practice, strength & conditioning, etc. Verification must be submitted to the Long Beach State Athletic Medicine staff prior to participation. For more information about the sickle cell trait and why it is tested for please refer to this NCAA Sickle Cell Fact Sheet.

Student-Athletes need to do one of the following:

1. Contact their parents/guardian and your pediatrician (at birth) and get documentation showing what your sickle cell trait status is. Infants born after 1984 were tested for the sickle cell trait and therefore the documentation should be available from your family pediatrician. If you were born in California, you can obtain this information by contacting the California Newborn Screening Program at (510) 412-1502. You will need the following information to obtain results: Your first and last name at time of birth, mother's first and last name at time of birth, date of birth, and the name of the hospital where you were born.*
   Use this form to assist with this process.
2. Schedule an appointment with your family physician. This test needs to be in the form of a blood test and documentation must be in the form of official blood test results, not a note from the physician.*
3. Long Beach State Athletics offers sickle cell screening in the form of a blood test to all of its student-athletes at no cost. Testing will be conducted at CSULB Student Health Services or another facility designated laboratory. Results must be returned to a Long Beach State athletic medicine staff member prior to participation.*

*Please note, it takes approximately 1-3 weeks to receive these results. Make sure to complete the blood test or request results in advance to assure on-time sport participation. Athletes will not be cleared for participation until results have been provided to the athletic training department.

You will be required to submit all completed physical forms for review PRIOR to your start date. They can be returned to the Long Beach State Athletic Training Room or mailed to the address below:

Long Beach State Athletic Medicine
Attn: Katie Davis
1250 Bellflower Blvd
Long Beach, CA 90840

Pre-participation physical forms will be available to returning athletes online through Jump Forward. All forms will need to be reviewed by a staff athletic trainer PRIOR to clearance for participation. Athletes will be cleared based on this review by the staff athletic trainer and/or team physician(s).

Returning athletes are required to complete, sign and provide any additional information as required by the forms located on Jump Forward. If you do not have a Jump Forward login, you will be provided with one this summer.

• If you had an injury/illness over the summer, please indicate this on your health history form with details and provide any supporting documentation (doctor's notes, test results, etc.)
• Returning athletes DO NOT require a physical unless requested by their athletic trainer. If you would like to be seen by a doctor prior to participation, please indicate this on your health history form and notify a staff athletic trainer.
• Returning athletes who are covered by an insurance policy will be required to provide a copy of their insurance card to the athletic training department.

Returning Athletes will be required to complete the following forms available on Jump Forward:

1. Returner's Health Screening Form 2012
2. Insurance Questionnaire 2012
3. Explanation of Insurance
4. Authorization for the Release of Medical Information
5. Informed Consent and Assumption of Risk
6. Authorization for Treatment

If you have been invited to try out for a team at Long Beach State you are required to do all of the following:

1. Print, complete, sign and return the forms provided below with any supporting documentation related to injuries, illnesses and/or medications.
1. General Med Physical Exam
2. Explanation of Insurance
3. Assumption of Risk
4. Sickle Cell Trait Form
5. Drug Testing Consent Form
2. Have a physical exam performed by a doctor (MD ONLY) using the "General Medical Exam" form provided here. Make sure to have this form signed and stamped by the physician performing the exam.
3. Provide verification of your Sickle Cell Trait status.

Once you have completed these steps you must return ALL forms with proof of insurance (a copy of your insurance card) to the Long Beach State Athletic Training Room for review by a staff athletic trainer and/or team physician to determine medical clearance.

1. Print, complete, sign and return the forms provided below with any supporting documentation related to injuries, illnesses and/or medications.
1. New Athlete Health Screening Form
2. General Med Physical Exam
3. Assumption of Risk
4. Authorization To Treat - (This is required to be filled out by a Parent/Guardian ONLY if the athlete is under 18.)
2. Have a physical exam, which must be conducted within the last 3 months prior to your evaluation, performed by a doctor (MD ONLY) using the "General Medical Exam" form provided here. Make sure to have this form signed and stamped by the physician performing the exam.
3. Provide verification of your Sickle Cell Trait status. If you have questions about obtaining your sickle cell status please refer to the section above.
4. You will not be able to work out until cleared by the Sports Medicine Staff, so PLEASE submit these documents prior to getting to campus. This will allow us time to review your documentation to make sure it is correct prior to your arrival and avoid any unnecessary delays.
   You can email the packets to jarrod.spanjer@csulb.edu, Fax them to the Sports Medicine Dept at (562) 985-7348, or mail them (make sure to send well in advance to ensure arrival before you get to campus):
   Long Beach State Athletics
   ATTN: Jarrod Spanjer
   1250 Bellflower Blvd. KIN 86
   Long Beach, CA 90840

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