PENN STATE ERIE, THE BEHREND COLLEGE



Penn State Behrend College Sports Medicine

General Policies and Procedures for Student-Athletes

This document outlines the rights and responsibilities of student-athletes regarding athletic health care. It is imperative that the student-athlete read and understand this information so that they know what to expect and what is expected of them in the event they suffer an injury or illness.

SPORTS MEDICINE STAFF: Refers to the certified athletic trainers, physicians and other health care personnel utilized in the health care of Penn State Behrend College student-athletes.

I. MEDICAL ELIGIBILITY

A. All student-athletes must pass a pre-participation physical examination administered by the Penn State Behrend College Sports Medicine Staff. Physical examinations performed by the athlete’s personal physician are not acceptable. It must be clearly understood that ALL intercollegiate athletes must receive this medical clearance before participation. The signature of the examining physician on the pre-participation examination form will present evidence of this medical authorization.

B. The student-athlete’s primary medical insurance information MUST be on file with the Sports Medicine Staff prior to taking the physical examination. Students who fail to produce this information will be prohibited from taking a physical examination and thus prohibited from participating in Athletic Department sponsored practices or competitions.

C. Athletic physical examinations are in effect for one year. The Sports Medicine Staff may re-examine or change the medical participation status of any athlete at any time during the athlete’s career at Penn State Behrend College.

D. A medical history is required from each athlete prior to taking a physical examination. Failing to document any previous or existing medical condition on this history form will release Penn State Behrend College from all financial liability for the unreported problem(s) and any subsequent related problems. IF ANY TESTS, X-RAYS OR REFERRALS ARE REQUESTED BY THE BEHREND SPORTS MEDICINE STAFF AS A RESULT OF FINDINGS DURING THE PHYSICAL EXAMINATION, FINANCIAL RESPONSIBILITY FOR THESE RESTS SOLELY WITH THE ATHLETE AND THEIR PERSONAL HEALTH INSURANCE.

E. Previous injuries, not fully rehabilitated, may disqualify any athlete from participation until approved by the Behrend Team Physician or consulting orthopedists. If a student-athlete is under care of a physician not associated with Penn State Behrend College, written permission must be presented to the Sports Medicine Staff stating the nature of the injury and the date the student may resume activity.

F. The Behrend Sports Medicine Staff may disqualify any athlete who has any condition for which participation in their chosen sport is contraindicated.

II. MEDICAL POLICIES FOR ATHLETES

A. It is the responsibility of the student-athlete to maintain a reasonable level of health. This means it is their responsibility to take proper care of themselves---including proper diet, fitness and sleep as well as avoiding behaviors that are potentially dangerous.

B. The athlete should promptly report all injuries and illnesses to a staff athletic trainer. Injuries/illnesses not noted during participation should be reported immediately after the practice/game or between the hours of 11:00 AM and 2:00 PM the next day. Failure to report a condition within three days results in the release of Penn State Behrend College from any financial responsibility for medical expenses for that condition.

C. In case of emergencies occurring outside of regular hours, contact a staff athletic trainer, the Behrend Health and Wellness Center or call 911.

D. All treatments will be given under the direction of a staff athletic trainer who works under the supervision of the Behrend Team Physician.

E. Decisions concerning participation status shall be solely at the discretion of the Penn State Behrend College Sports Medicine Staff.

III. MEDICAL REFERRAL POLICIES

A. Except in emergencies, a staff athletic trainer MUST screen all conditions prior to referral to a team physician or other consultant.

B. The Sports Medicine Staff will make referral appointments. Transportation to medical facilities/offices located off-campus will be provided by the Sports Medicine Staff ONLY if the athlete is unable to arrange personal transportation.

C. All orthopedic evaluations will be done for the Department of Athletics through associated consultants of St. Vincent’s Sports Medicine. This policy assures proper and immediate care, close follow-up treatment and smooth injury management for the student-athlete and the Behrend Sports Medicine Staff.

D. If a student-athlete desires a second opinion, the student-athlete is required to request a referral form, which must be updated by the physician and returned to the Sports Medicine Staff before consideration of resumption of activity is allowed.

E. A consultation between the parents of any athlete and the Behrend Sports Medicine Staff will be arranged whenever requested. All decisions regarding medical approval or disqualification in the intercollegiate athletics program will be made solely the Behrend Team Physician and/or associated consultants.

F. The Behrend Sports Medicine Staff reserves the right to require referral to an outside medical agency for the evaluation, treatment and/or rehabilitation of any problem not related to athletics.

Any student-athlete incurring an illness at a time outside the dates of traditional or non-traditional seasons, may be required to report to the Penn State Behrend College Health and Wellness Center for treatment.

IV. MEDICAL EXPENSE PAYMENT POLICIES

All participants are required to show proof of medical insurance prior to having a physical examination. This policy must provide benefits for athletic related injury. A front and back copy of the participant’s primary insurance card must be on file before the student-athlete will be allowed to participate in any practice or competition.

Student-athletes whose families do not have an insurance plan are encouraged to purchase an insurance package that does not exclude NCAA intercollegiate athletic sports injuries.

B. Penn State Behrend College will ONLY be financially responsible for injuries occurring while an athlete is representing the College in formal intercollegiate activity, which is supervised by a coach. Care for illnesses such as colds, flu, etc. will only be covered during a sport season in which the athlete is engaged in formal full-team practices supervised by a coach.

Penn State Behrend College’s Athletic Department requires that bills be submitted first to the primary health insurance company of the athlete and his/her parent or guardian. Penn State Behrend College retains a secondary excess policy in conjunction with The Pennsylvania State University’s Department of Risk Management. This secondary policy will pay ONLY AFTER primary insurance has been engaged and only for athletic-related injuries.

The Sports Medicine Staff will handle acute care and rehabilitation of minor injuries at no cost whenever possible. The Sports Medicine Staff will see that individual student-athletes receive the best treatment available while following the guidelines of his/her primary health insurance policy. It is the responsibility of the student-athlete to inform the Sports Medicine Staff of any peculiarities and changes in his/her medical insurance coverage (i.e. HMO, PPO). If services are rendered while there is a lapse in coverage, the student–athlete will be responsible for all charges incurred during this lapse. Please let the Sports Medicine Staff know of any questions that may arise concerning the medical coverage of a student-athlete.

Arrangements for follow-up care with a physician for injuries incurred during athletic activity must be completed within a 14 day period after completion of the competitive season, eligibility or termination from the team. After said period, Penn State Behrend College is no longer financially responsible for any expenses incurred as a result of said injury, unless other arrangements have been made with the Sports Medicine Staff.

CONTACT NUMBERS FOR SPORTS MEDICINE STAFF

JEFF WEBSTER ATC---HEAD ATHLETIC TRAINER (office) 814-898-6340

Email jxw63@psu.edu

ANGE MESEROLE ATC---ASSISTANT ATHLETIC TRAINER (office) 814-898-7227

Email amm43@psu.edu

JEFF HAFT ATC---ASSISTANT ATHLETIC TRAINER (office) 814-898-6017

Email jmh73@psu.edu

ST. VINCENT’S SPORTS MEDICINE 814-835-2035

ST. VINCENT’S MEDICAL CENTER EMERGENCY ROOM 814-452-5353

PENN STATE BEHREND HEALTH & WELLNESS 814-898-6217

ATHLETIC TRAINING ROOM POLICIES AND PROCEDURES FOR ATHLETES

❖ Athletic Training Room Hours:

o M-F: 2:00 PM – 7:00 PM (or until last practice ends)

o SAT-SUN Pending scheduled practices/events

For practices/competitions outside of these hours, the facility will open 1 hour prior to the time the team is required to report, or as specified by the staff athletic trainer.

o Morning times (prior to 2 PM) are by appointment for prescribed rehabilitation.

❖ The Athletic Training Room is a co-ed facility. Proper dress is required for treatment. Please wear shorts and a t-shirt at all times.

❖ Showers are MANDATORY before receiving post-practice/post game treatments.

❖ Treatments are available to intercollegiate athletes only; in season athletes have priority.

❖ Injuries not sustained during intercollegiate functions are not the responsibility of the Sports Medicine Staff. Treatment of these injuries will not be the responsibility of the Sports Medicine Staff.

❖ The Athletic Training Room operates on a first-come first-serve basis. Come early if you want to avoid the rush.

❖ You are responsible for getting your taping or treatments done in time for all meetings and practices. Remember you are never late for practice because you were detained in the Athletic Training Room, you simply did not arrive early enough. EXPECT THE ATHLETIC TRAINING ROOM TO BE BUSY!

❖ Team physicians will be available periodically in the Athletic Training Room. Athletes must see a Sports Medicine Staff member prior to seeing a physician in the Athletic Training Room.

❖ Athletes must check in with an athletic trainer prior to beginning treatment or using any equipment.

❖ Appropriate treatment for any and all musculoskeletal injuries will be decided on only by a Sports Medicine Staff member. When necessary (as deemed by the athletic trainer), the team physician will be involved.

❖ Continue all treatments until the staff athletic trainer releases you. Do not stop treatments just because your injury feels better. If you miss a treatment, you will be assumed to be healed, and thus okay to practice.

❖ Taping will be performed only as deemed necessary by the Sports Medicine Staff. Taping must be accompanied by prescribed exercise. Braces may be utilized in lieu of routine taping at the discretion of the Sports Medicine Staff.

❖ No athlete is permitted to operate athletic training room equipment --- No Self Treatments.

❖ All equipment is to stay in the Athletic Training Room unless issued by a staff member. Student-athletes will be billed for equipment not returned unless specified by a staff member. Failure to remit payment for equipment not returned will result in records being placed on hold by the College.

❖ No food or drink please.

❖ The facility is not to be used as a lounge or place to socialize. NO LOITERING.

❖ No form of harassment, sexual or otherwise, will be tolerated. This includes language, gestures or implied comments.

❖ Individuals not abiding by these policies will be asked to leave the facility, refused service and/or will be reported to the respective head coach and athletic director for disciplinary action.

❖ Finally and most importantly, COMMUNICATE WITH YOUR ATHLETIC TRAINERS!!!! We are here to help you, not hinder you.

Penn State Erie, The Behrend College

Athletic Department/Sports Medicine Services General Policies

1. Risk of Injury: Intercollegiate athletics may constitute a dangerous activity involving the risks of injury. Those dangers and risks of playing or practicing include, but are not limited to death, severe neck and spinal injuries, which may cause complete or partial paralysis, brain damage, severe internal injury, severe injury to bones, joints, ligaments, muscles tendons and other aspects of the musculoskeletal system. It is understood that such injury may result in serious impairment of future abilities to earn a living, to engage in other businesses and generally enjoy life.

2. General Policy Statement: Our purpose is to provide the best medical care possible for all athletes. Penn State Erie, The Behrend College Athletics carries medical insurance for all injuries directly related to participation in practice or university sponsored athletic competition. We will act as the secondary providers while your personal or parents insurance will act as the primary coverage in such events. It is strongly recommended that you or your parents carry insurance to cover any non-athletic injuries or illnesses since these are not covered by Penn State Erie, The Behrend College.

3. NCAA Bylaws Section 16.4: According to NCAA rules, only sickness or injury directly related to participation in intercollegiate athletics may be financed by the member institution. If sickness or injury occurs in classes, outside of class, or in extra-curricular activities that are not athletically related, it cannot be financed by the member institution. If an athlete enters the institution with a pre-existing injury or condition, the member institution will not finance any medical expenses for that injury/condition.

4. All Student-Athletes: In order for any student-athlete to participate in intercollegiate athletics while enrolled at Penn State Erie, The Behrend College, proof of primary medical insurance coverage must be provided. All costs for medical treatment, which results from injuries sustained while participating in intercollegiate athletics, must be covered by a primary health insurance plan. In order to take the pre-participation physical exam, all student-athletes must provide Sports Medicine Services with proof of this insurance. Proof of insurance shall include a specific insurance company and policy number.

5. Medical Referrals: If you see a doctor without proper authorization, you will incur all responsibility for expenses.

6. Dental & Eye Care: Only dental and eye injuries directly related to intercollegiate athletics participation can be financed by Penn State Erie, The Behrend College. All other problems should be reported to Sports Medicine Services for proper referral.

7. Problems at Night & Emergencies: When the athletic training room is closed and you need the services of the Sports Medicine Staff, call the athletic training room at 898-6340, 898-7227 or 898-6017. If you are unable to reach the athletic trainer and your emergency is severe, try to contact your head coach and go to the nearest hospital emergency room. However, you must notify the Sports Medicine Staff the following morning.

Student-Athlete Authorization/Consent For Disclosure of Protected Health Information to the National Collegiate Athletic Association

I,       hereby authorize Penn State Behrend College

Name of Student-Athlete

and its physicians, athletic trainers and health care personnel to disclose my protected health information and any related information regarding injury or illness during my training for and participation in intercollegiate athletics to the National Collegiate Athletic Association (NCAA) and its employees or agents.

I understand that my protected health information will be used only by the NCAA’s Injury Surveillance System (ISS) for the purpose of conducting research on injuries resulting from training for or participating in athletics. The ISS is a longitudinal research database that provides the NCAA, NCAA sports rules committees, athletic conferences, researchers and individual schools with summary (aggregate) injury and participation information that does not identify individual athletes or schools. The summary data provide the Association and other groups with an informative resource upon which to base health and safety rules and policy and to examine the effectiveness of such efforts.

I understand that my injury/illness information is protected by federal regulations under either the Health Information Portability and Accountability Act (HIPAA) or the Family Educational Rights and Privacy Act of 1974 (the Buckley Amendment) and may not be disclosed without either my authorization under HIPAA or my consent under the Buckley Amendment. I understand that my signing this authorization/consent is voluntary and that Penn State Behrend College will not condition or withhold any health care treatment or payment, enrollment in a health plan or receipt of any benefits (if applicable) on whether I provide the consent or authorization requested in this disclosure. I also understand that I am not required to sign this authorization/consent in order to be eligible for participation in NCAA athletics.

I understand that HIPAA regulations do not apply to the NCAA’s use or disclosure of my injury/illness information, the NCAA is committed to protecting my privacy. I understand that the protected health information will be encoded before being transmitted from Penn State Behrend College to the NCAA and that neither the NCAA nor the ISS will identify me personally in any publication or disclosure of research results. Data will be stored on a secure server at the NCAA national office in Indianapolis, Indiana.

This authorization/consent expires 380 days from the date of my signature below, but I have the right to revoke it in writing at any time by sending written notification to the athletic director or athletic trainer at Penn State Behrend College. I understand that a revocation takes effect on its request date and does not affect any action taken prior to that date.

***See page 9 of this packet for authorizing signature.***

Penn State Behrend College Athletic Department

Assumption of Risk Form

(Shared Responsibility for Sport Safety)

A statement of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports-August 1978/reissued March 1979

Participation in sports requires an acceptance of risk of injury. Athletes rightfully assume that those who are responsible for the conduct of sports have taken reasonable precautions to minimize the risk of significant injury. Periodic analysis of injury patterns continuously leads to refinement in the rules and/or safety guidelines. However, to legislate safety via the rule book and equipment standards, while often necessary, is seldom effective in and by itself. To rely on officials to enforce compliance with the rulebook is as insufficient as to rely on warning labels to produce behavioral compliance with safety guidelines. Compliance means respect everyone’s part for the intent and purposes of a rule or guideline, not merely technical satisfaction with some of its phrasing.

Some sport safety problems lend themselves readily to identification and solution (e.g. heat stroke and administration of liquid freely during early football practice). Some safety problems may be less clearly identified (e.g. head injuries) and solutions may be developed on selective assumptions and the premise that measurable standards are better understood than qualitative rhetoric (e.g. purchase a helmet manufactured in accordance with NOCSAE standards instead of purchasing the “best helmet possible”). Some safety problems remain problems because of questionable compliance with legislated solutions (e.g. dental mouth guards).

The athlete should be acquainted with the risks of injury respective to their specific sport and knowledgeable concerning the rules and practices they are employing to minimize his/her risk of significant injury while pursuing the many benefits of sports. The student-athlete and the Athletic Department at Penn State Behrend College have a mutual need for an informed awareness of the risks being accepted and for sharing the responsibility for controlling these risks.

At Penn State Behrend College, every effort is made to control the risk of injury. The Sports Medicine Staff participates in the NCAA Injury Surveillance System for a number of sports in order to examine trends in athletic injury. Once trends have been identified, steps are taken to control the risks and causes of these trends. In addition, the latest strength and conditioning techniques are employed, realizing that a well-conditioned athlete has a lower risk of injury.

Even with the current programs and techniques being employed, it should be understood that a certain amount of injuries will occur, including the possibility of catastrophic injury, or even death. The student-athlete and his/her parents should be cognizant of this fact and understand that at Penn State Behrend College, every possible step is being utilized to make sports participation as safe as possible.

I certify that I have read and understand the above statement and agree to accept the shared responsibility for my safety as a student-athlete at Penn State Behrend College.

***See page 9 of this packet for authorizing signature.***

Penn State Erie, The Behrend College Sports Medicine Services

Authorization for Routine Release of Information

The undersigned student-athlete or authorized representative requests and authorizes Penn State Erie, The Behrend College Department of Athletics to release routine student-athlete’s athletic health information as described below.

A. Health Information to be released. I am authorizing release of routine health and injury information. Routine health and injury information includes information pertaining to injuries occurring during practice, games, competitions and other sanctioned Penn State Erie, The Behrend College athletic events.

a. Recipient: This authorization is valid for release of information to the media, including local and national media, Penn State Erie, The Behrend College’s Public Relations and student media.

B. Purpose. Penn State Erie, The Behrend College’s Department of Athletics is seeking this authorization in order to coordinate in advance, the management of each student-athletes’ health information.

C. Expiration. This authorization expires one year from the date signed.

D. Explanation of Rights. I, as student-athlete/student representative, understand that:

• I may refuse to sign this authorization for routine disclosures.

• I have the right to revoke this authorization at any time, provided that I submit my written revocation to the Head Athletic Trainer, Penn State Erie, The Behrend College, 5103 Station Road, Erie, PA 16563.

• Any revocation of this authorization does not apply to disclosures already made by Penn State Erie, The Behrend College in reliance of this authorization or for disclosures otherwise required by law.

• I have the right to review my Athletics Department health records before signing this authorization.

• It is possible that the person/entity authorized by my signature to receive the above health record(s) has no duty to protect the confidentiality of records disclosed to them. There is a risk that the recipient may re-disclose the information.

E. Authorization.

I HAVE READ AND UNDERSTAND THIS FORM. I AM SIGNING IT VOLUNTARILY. I AUTHORIZE THE DISCLOSURE OF MY PENN STATE BEHREND COLLEGE ATHLETICS’ HEALTH INFORMATION AS DESCRIBED IN THIS FORM.

***See page 9 of this packet for authorizing signature.***

PLEASE COMPLETE ALL THE INFORMATION ON THIS PAGE

Name:                  

Last First M.I.

Sport:      

Please read this very carefully. If you have any questions, please bring them to our immediate attention.

We, the undersigned, have read and understand all the forms listed below. By checking the following boxes and affixing our signatures below, we agree to follow the policies and procedures set forth by the Penn State Behrend Sports Medicine Department and the Penn State Behrend Athletic Department. We understand that failure to adhere to these policies and procedures may result in delays for insurance claim payments, delays in release of medical information and/or my being barred from using the Penn State Behrend Sports Medicine Staff and Athletic Training Facilities.

NCAA HIPAA Form

Assumption of Risk Form

Authorization for Routine Release of Information Form Athletic Department General Policies Form

Athletic Training Room Policies and Procedures for Athletes Form

General Policies and Procedures Handbook

_____________________________________________

Student Athlete Signature

____________________

Date

Please return this page only along with a completed copy of the Athlete Insurance / Medical History Forms to the following address:

Sports Medicine/Athletic Training Services

Penn State Behrend College

5103 Station Road

Junker Center

Erie, PA 16563-0400

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