Pre-Participation Physicals & Forms

All NEW athletes are required to:

• 1) Complete, sign and provide any additional information required by all paperwork provide below.
• 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.

Required Forms for All NEW Athletes:
New Athlete Medical History
General Medical Exam
Orthopedic Evaluation
Insurance Questionnaire
Explanation of Insurance
Authorization of Treatment (if under 18)
Informed Consent Form
Sickle Cell Trait Form
Assumption of Risk Form

General Medical 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. (Athletes must use the forms above when visiting their physician)
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.

Lab Work
Each athlete will have blood work (CBC) and Urinanalysis (UA) performed. Testing will be completed at the Student Health Center on campus or may be completed by personal physician if preferred. (Copy of results must be submitted with other paperwork.)

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. 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. Please Use This Form
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.

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: Mark Pocinich
1250 Bellflower Blvd
Long Beach, CA 90840

Please contact the athletic training room at (562) 985-7154 or any of our staff members with any questions.

All returning athletes are required to complete, sign and provide any additional information as required by the paperwork below.

• 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.)
• 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.

These forms must be printed, completed and returned to the training room in person or by mail. 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 he staff athletic trainer and/or team physician(s).

Required Forms for All RETURNING Athletes:
Returning Health History
Insurance Questionaire
Explanation of Insurance
Informed Consent Form
Assumption of Risk Form

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.
2. Have a physical exam performed by a doctor (MD ONLY) using the "General Medical Exam" form provided below.
3. Provide verification of your Sickle Cell Trait status.

Once you have completed these steps you must return ALL forms to the Long Beach State Athletic Training Room for review by a staff athletic trainer and/or team physician to determine medical clearance.

Required Forms for all TRY-OUTS:
New Athlete Medical History
General Medical Exam
Insurance Questionnaire
Explanation of Insurance
Informed Consent Form
Sickle Cell Trait Form

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