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Untitled Document

Pre-Participation Physicals & Forms


New Athletes | Returning Athletes | Tryouts | On-Campus Evaluations


NEW ATHLETES

Dear Incoming Student-Athletes,

The Sports Medicine Department would like to welcome you to Long Beach State! We are very excited that you have chosen to pursue athletics here and look forward to working with you. All athletes are required to complete the following documentation PRIOR to clearance for participation:

  1. Please PRINT out all forms below and turn them into the Sports Medicine department. All forms will need to be reviewed by a staff athletic trainer and athletes will be cleared based on this review by the staff athletic trainer and/or team physician(s). These are the forms that will need to be completed:
    1. New Athlete Health History Form
    2. Insurance Questionnaire
    3. Authorization to Release Medical Information
    4. Assumption of Risk
    5. Informed Consent, Acknowledgement and Assumption of Risk
    6. Authorization for Treatment (only fill out if athlete under 18 y/o)
    7. Explanation of Insurance - ALL athletes and their parent(s)/guardian(s) should read and print a copy for your records. You do not need to turn this into Sports Medicine.
  2. Have a comprehensive physical exam prior to participation in athletic activities which includes:
    • General Medical Exam
    • Lab Work (need a CBC and Urine Analysis)
    • Orthopedic Exam - which will be performed upon arrival to campus
  3. Provide verification/results of Sickle Cell Trait Status. For information on Sickle Cell see information below.

General Medical Exam
Athletes have three options to complete their general medical exam:

  1. Schedule an appointment with our team physicians during the summer (free & recommended by sports medicine 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 a Long Beach State athlete when making the appointment so you aren't charged.
  2. See your 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.
    • Your physician MUST USE OUR FORMS when completing your physical. All forms will need to be provided to the athletic training staff at your sport's physical date.
  3. Attend the physical date for your sport listed below.

Physical Dates:

DateTimeSport
Tuesday, Aug. 52 p.m.Women's Soccer
By Appointment--Women's Volleyball
Wednesday, Aug. 132 p.m.Cross Country
Monday, Aug. 182 p.m.Men's Water Polo
Wednesday, Aug. 272 p.m.ALL Sports
TBATBAALL Sports
LOCATION: Athletic Training Room - KIN Building Room 86

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 completed by a personal physician if preferred at your own expense (a copy of results must be submitted with other physical paperwork). Please contact the sports medicine department if you wish to have testing completed at the Student Health Center so that we may provide you with the necessary blood work forms.


SICKLE CELL TRAIT STATUS

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 online at the California Department of Public Health website. You must use the submit button to send the data electronically to them via their email system. The PC requires the use of Internet Explorer. Also, if the blue button form (it's the one that says it is a PC version) doesn't work, try the red button (the one that says it is the Mac version). One or the other should work for most computers. Electronic submission does not mean print out the form, scan and send. If that happens, it goes to the bottom of the data entry pile (which is incredibly large these days!) and it will take a lot longer for Long Beach State to receive results.
  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 Sports Medicine
Attn: Jarrod Spanjer
1250 Bellflower Blvd
Long Beach, CA 90840


RETURNING ATHLETES

Returning athletes are required to complete, sign and provide any additional information as required by the forms located below. 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).

  • 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 an 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 are required to fill out the Insurance Questionnaire each year and will be required to provide a copy of their insurance card to the Sports Medicine Department.

Returning Athletes are required to PRINT out all forms below and turn them into the Sports Medicine department:

  1. Returner's Health Screening Form
  2. Insurance Questionnaire
  3. Authorization to Release Medical Information
  4. Assumption of Risk
  5. Informed Consent, Acknowledgement and Assumption of Risk
  6. Explanation of Insurance - ALL athletes and their parent(s)/guardian(s) should read and print a copy for your records. You do not need to turn this into Sports Medicine.

TRY-OUTS

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. New Athlete Health History Form
    2. General Med Physical Exam
    3. Assumption of Risk
    4. Informed Consent, Acknowledgement and Assumption of Risk
    5. NCAA Drug Testing Consent Form
    6. Authorization for Treatment (only fill out if athlete under 18 y/o)
    7. Sickle Cell Trait 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. If you have questions about obtaining your sickle cell status please refer to the section above.

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.


ON-CAMPUS EVALUATIONS (M/W Basketball)  
If you have been invited to try out for one of our basketball teams 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. New Athlete Health History Form
    2. General Med Physical Exam
    3. Informed Consent, Acknowledgement and Assumption of Risk OCE
    4. Authorization for Treatment (only fill out if athlete under 18 y/o)
  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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