STUDENT-ATHLETE'S MEDICAL PACKET

Below in the WSU Student-Athlete medical packet. Please read the following policies and fill out all the forms that are listed. You can download all the forms using Adobe Reader.

 

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Student-Athlete's Personal Information

Student-Athletes Information Form

 

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Student-Athlete Medical Questionnaire

Medical History Questionnaire

 

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MEDICAL POLICIES AND PROCEDURES
FOR STUDENT-ATHLETES

 

Medical Policies and Procedures

 

MEDICAL POLICIES AND PROCEDURES
FOR STUDENT-ATHLETES

 

The following is a summary of the athletic department medical policies and procedures for student-athletes attending Wichita State University.  We hope that this will help to answer some of your questions concerning the health care that will be provided for your son or daughter and the financial responsibility of the athletics department, the student-athletes and their parents or guardians.

 

PRE-SEASON PHYSICAL EXAMINATIONS

 

1. All student-athletes must undergo a complete physical examination each year prior to participation or practice with any athletic team. The examination will be given by the team physician at a site and date determined by the athletic training staff after consultation with the head coach.

 

2. Any student who desires to participate in any sport, who does not undergo the physical examination by the athletic department during the first week of class will be scheduled for a physical with the WSU team physicians at the physician’s next regularly scheduled visit.  This physical examination must be completed before permission to participate in any physical activity is granted.

 

PREVIOUS INJURY OR ILLNESS

1. If any medical defect or illness is discovered, the student-athlete will NOT be permitted to play or practice until cleared by the team physicians. The team physicians will have the final say in determining if a student-athlete is physically fit to participate in athletics at Wichita State University.

 

2. The athletic department will NOT pay the cost to repair any previous injury incurred prior to reporting for any athletic program on the date set by the head coach. This includes congenital defects. All medical tests ordered by the team physicians to determine a student-athlete's playing status after the initial physical examination will be the financial responsibility of the student-athlete and his/her parents or guardians.

 

PAYMENT OF MEDICAL EXPENSES - WSU AND PARENTS OR GUARDIANS

 

1. The athletic department has a secondary medical insurance policy that will cover the cost of treatment for all athletic injuries incurred in official practices, scrimmages, conditioning, weight training, or scheduled contests provided the injury was reported to the athletic training staff in a timely manner.

 

2. All athletic injuries must be reported to the athletic training staff immediately. This includes dental injuries to sound teeth, bridges, partial plates, and plates.

 

3. The athletic department can only pay for dental injuries incurred during supervised practices, scrimmages, conditioning, weight training, or scheduled athletic contests. The ICAA will NOT pay for normal dental work such as dental cavities, crowns to repair decayed teeth or any orthodontic work. It is the responsibility of the student-athlete and his/her parents or guardians to pay for these expenses.

 

4. The athletic department will NOT pay for any general medical conditions.  Furthermore, the athletic department will NOT pay for vitamins, minerals, supplements, prescription medications or any other over the counter medications not carried by athletic training services.  The athletic department will NOT pay for medications related to pre-existing medical or orthopedic conditions (i.e., inhalers, NSAID’s, etc.).  The athletic department will NOT pay for custom orthotics.  Any charges related to the above mentioned items will be the responsibility of the student-athlete and his/her parents or guardians.

 

5. WSU's medical insurance is an excessive coverage insurance policy that requires WSU to file all claims with the parent's medical insurance first and then WSU's policy will cover all expenses not covered by the parent's insurance.  It is very important that you notify the athletic training staff of any medical expenses that your company has paid or rejected. Please send a copy of your summary of benefits form to the "Athletic Trainer" as soon as you receive a payment or rejection notice. This will help to expedite the payment process.  WSU will process all prescription medicines through the parent's insurance company.  WSU will pay the "co-pay" for prescriptions for athletic injuries only.  Parents must pay "co-pay" and/or prescription costs for non-athletic injuries (i.e., illness or injuries occurring outside of practice/competition).

 

6. All student-athletes who wear hard or soft contact lenses must register them with the athletic training staff prior to the athletic department accepting any responsibility for lost or damaged contact lenses.  All damaged or lost contact lenses must be reported to the team athletic trainer.  The athletic department will only pay for disposable contact lenses while the student is enrolled as a full-time student.  Please send a copy of your son’s or daughter’s prescription with these forms.

 

7. Second Medical Opinions – The athletic department will NOT be financially responsible for any “second opinions”.  If the medical procedure is not capable of being performed in the city of Wichita, an exception may be granted.  Furthermore, the athletic department will NOT be financially responsible for any medical procedures that are not recommended by our team physicians.

 

8.  Post-Participation Insurance Coverage - Wichita State University realizes that certain injuries that are the direct result of intercollegiate athletic participation may require additional medical attention after a student-athlete has exhausted his or her eligibility or discontinues participation in athletics at Wichita State University.  Therefore, secondary coverage is provided for sixty days after the date of a student-athlete's last competition or departure from a team.  Therefore, any medical bills dated after the sixty day window become the responsibility of the student-athlete. This coverage is dependent upon documentation of injury, reasonable adherence to medical advice during rehabilitation and no further evidence of post-competition re-injury.  Each case will be individually reviewed for strict adherence to these guidelines.

 

9. If at any point a student-athlete makes his or herself ineligible by signing with an agent, signing a professional contract, or by any other means makes themselves ineligible for intercollegiate athletics, then you waive your right to medical coverage at that time.

 

10. The athletic department is only financially responsible for a maximum of two off campus rehabilitation visits or consultations per student-athlete per covered medical condition as determined by the head athletic trainer.

 

11. Student-athletes who do not follow the recommendations of the designated athletic department attending physician and/or athletic trainer for treatment of injuries (such as rest and/or rehabilitation) during the summer months or any other time when school is not in session, will no longer be the financial responsibility of the athletic department.

 

12. The athletic department is NOT financially responsible for injuries incurred by non-roster, walk-on student-athlete’s who are trying out for an athletic department team until the head coach designates them as a permanent roster member.

 

CLEARANCE TO PARTICIPATE IN INTERCOLLEGIATE ATHLETICS

Student-athletes will be cleared to participate in all practices, weight training, conditioning, or athletic contests when they have passed their physical examination by the team physician and they have the following forms on file in the athletic training staff's office.

 

1. Completion of the Student-Athletes Information Form signed by the policyholder.

2. Copy of medical, prescription, vision, and dental insurance cards.

3. Medical History Questionnaire

4. Proof of immunizations for tetanus/diphtheria, measles, mumps, rubella, and Tuberculin prior to participation.  Meningitis and Hepatitis B are recommended.

5. Proof of sickle cell hemoglobin electrophoresis testing, with results that have been interpreted by a qualified member of the WSU-ICAA medical staff.

6. Policy Acknowledgement Form signed and dated by the student-athlete and/or parent or guardian, with student-athlete’s initials next to the name of each policy stating they have read, understand, and agrees to each policy.

If you should have any questions concerning the athletic department medical policies and procedures listed above, please feel free to contact the athletic department for further information.
 

(Policy Update 7/31/2012)

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   Wichita State University-ICAA Consent Form

 

 Wichita State University-ICAA Consent Form

 

 

Consent to treatment:

By signing the Policy Acknowledgement form, I hereby grant consent for treatment or services to be provided by WSU-ICAA athletic training staff.  I also certify that no guarantee or assurance has been made as to the results that may be obtained.

 

Disclosure of Protected Health Information:

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 of this authorization/consent is voluntary and that my institution will not condition 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 for this disclosure.  I also understand that I am not required to sign this authorization/consent in order to be eligible for participation in NCAA or conference athletics.

 

I understand that my protected health information will or could be used by the Missouri Valley Conference, local, regional and national media, the Via Christi Regional Medical Center and related medical professionals, the WSU-ICAA athletic training staff and/or WSU-ICAA officials for purposes of providing athletic training and medical services, reporting and providing information about WSU Intercollegiate Athletics, and communications with the Conference.

I herby consent to and authorize Wichita State University and/or the WSU Intercollegiate Athletic Association, Inc. and its physicians, athletic trainers and health care personnel to disclose protected health information and any related information regarding any injury or illness during my training for, and participation in, intercollegiate athletics to the individuals or entities noted above for the purposes stated.  I also consent to and authorize the release of protected health information to my parents or guardians.

 

I also understand that the Missouri Valley Conference and local, regional and national media are not covered by the Buckley Amendment or HIPAA and that these legal requirements will not apply to the Missouri Valley Conference and local, regional and national media’s use or disclosure of my injury/illness information.

Insurance assignment of benefits:

 

I hereby assign to the designated physician and/or hospital payment of medical benefits otherwise payable to me.  This authorization is valid for any and all insurance claims filed in behalf of the designated physician and/or hospital.  This authorization is valid until written notice of cancellation is received by the designated physician and/or hospital.

Expiration or revocation:

 

This authorization/consent expires 380 days from the date of my signature on the Policy Acknowledgement Form, but I have the right to revoke it in writing at any time by sending written notification to the Athletic Director at Wichita State University.  I understand that a revocation is not effective to the extent action has already been taken in reliance on this authorization/consent.  I further agree that a photocopy of this authorization/consent has the same force and effect as an original.
 

(Policy Update 1/13/2011)

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WSU-ICAA Drug Testing Program

 

WSU-ICAA Drug Testing Program 

 

Student-Athlete Health Care
WSU-ICAA Drug Education/Testing Program

 

 

WSU-ICAA Drug Education/Testing Program

 

Wichita State University administration, athletic department, and student-athletes recognize that drug abuse cannot be tolerated in the operation of or participation in intercollegiate athletics.  It is known that the illegal use of drugs poses a danger to the health and safety of the users and possibly people associated with a user, such as teammates. Drug abuse also damages the integrity and reputation of all student-athletes, the institution, and the Athletic Department, and it undermines fairness in competition between individual student-athletes and between teams.

 

 

It is the purpose of this policy to educate student-athletes and Athletic Department staff members to the dangers that drug abuse poses to the health and safety of student-athletes. Given this major concern for the student-athletes' health and safety, the University may also attempt, through drug screening, to deter the illegal use of drugs. It is the intent of the University to refer for professional medical assistance and counseling any student-athlete identified as having a substance abuse problem, including alcohol, in order to promote the physical and psychological well-being of the individual.

 

Those subject to the policy:

 

All student-athletes are subject to compliance with this policy. A student-athlete is any participant on an intercollegiate squad, regardless of athletic financial assistance. All student-athletes who accept the privilege of participating in intercollegiate athletics for the University are subject to drug testing. Participants in intercollegiate athletics are free to refuse drug testing; however, those who refuse will not be allowed the privilege of participating in intercollegiate athletics for the University. Also, refusal to consent to be tested for illegal drug abuse will result in the forfeiture of all financial assistance provided to a student-athlete by the Athletic Department.

 

Education Program:

 

The University recognizes that education regarding drug abuse may be the best deterrent and therefore will attempt to provide educational information to student-athletes. A strong effort will be made to have experts in the field address the student-athlete population. Because of the importance of such presentations, attendance by student-athletes will be mandatory. The Student-Athlete Advisory Committee will coordinate educational programming; any student-athlete who has questions regarding drugs, including alcohol, is encouraged to contact a member of the committee, who will make every effort to provide complete information. The Athletic Department will participate in the university-wide approach to peer education.

 

Prohibited Drugs:

 

It is prohibited under this policy to illegally use any controlled substance, as defined by the Kansas law (KSA 65-4101 et seq. and 65-4127a et seq.). Also, it is prohibited to use any mind or mood altering controlled substance or substances that affect athletic performance, other than those being taken properly pursuant to the medical doctor's prescription.  Prohibited drugs are:
1. Amphetamines
2. Barbiturates
3. Benzodiazepines
4. Cannabinoids (marijuana)
5. Cocaine
6. Methaqualone
7. Opiates
a. Morphine
b. Codeine
8. Phencyclidine (PCP)
9. LSD
10. Anabolic Steroids

Student-Athlete Health Care
WSU-ICAA Drug Education/Testing Program

 

In the event a student-athlete has a question regarding prohibited drugs, he or she should contact the Head Athletic Trainer or his designee.

 

Drug Testing:

 

All student-athletes will be required to read this policy and sign a consent statement indicating that they understand it and are willing to comply with its provisions, including drug testing. A student-athlete who refuses to comply with this policy will forfeit his or her privilege of participating in intercollegiate athletics and will have his or her athletically related aid revoked. Also, each sport program will have policies in place that will detail coaches expectations regarding drug/alcohol use and specific sanctions associated with any positive tests. Selection of student-athletes for testing may be made on a team basis. In addition, individuals may be tested when probable/just cause exists to suspect drug abuse. Testing of a student-athlete and/or team may occur if requested by a coach, administrator, athletic trainer or team physician. For those teams that are too large to test at one time, groups of the team will be identified and tested at different times (for example, the baseball team may be divided into outfielders, infielders, and pitchers and catchers.)  The Head Athletic Trainer, in consultation with the Senior Associate Athletic Director will determine the time and the circumstances for a particular team or team grouping to be tested. The testing may be announced or unannounced.

 

Reasonable effort will be made to ensure confidentiality of the drug tests, which will be conducted by a qualified laboratory using a chain of custody procedure to protect the identity and integrity of each specimen.

 

 

Drug testing shall consist of the collection of a urine sample from the student-athlete under the direct supervision and observation of qualified laboratory personnel.  The donors' names will be replaced with coded designations prior to sending the samples to the outside agency for testing. Each urine sample shall be analyzed for the presence of prohibited drugs. The laboratory shall report all test results to the Head Athletic Trainer within one week, and the Head Athletic Trainer will review such results to determine which, if any, of the test results are positive. A positive result shall mean a test result that indicates, in the opinion of the laboratory performing such testing, the presence of prohibited drugs in the student-athlete's urine. All drug screening tests are subject to a two-tiered testing procedure which involves an initial immunologic assay test followed by a gas chromatography/mass spectroscopy confirmation test if the initial test is positive.  Both tests are performed prior to notification of the results.  The Head Athletic Trainer will notify the Senior Associate Athletic Director of the outcome of each positive test.

 

A student-athlete who has tested positive will also be notified of the actions outlined below that will be taken.

 

 

Student-athletes who dispute the final test results and/or actions will have an opportunity to appeal, by personal appearance, to the Student-Athlete Appeals Committee before any action is taken. The Student-Athlete Appeals Committee shall consist of the Faculty Representative to the NCAA, University ICAA Sports Psychologist, Associate Athletic Director for Compliance, and the President and Vice President of the Student-Athlete Advisory Committee.

 

A student-athlete must notify the Senior Associate Athletic Director of his or her desire for appeal within 24 hours after receipt of the notification of action to be taken. If additional information is presented to raise the possibility of a false positive, the Senior Associate Athletic Director will discuss the new information with the Head Athletic Trainer.  The Senior Associate Athletic Director and Head Athletic Trainer will decide whether to accept the evidence of a false positive or to convene the drug policy grievance panel.  If the latter is decided, the Senior Associate Athletic Director will then arrange a closed hearing before the Student-Athlete Appeals Committee and notify all parties of the time and location of the hearing. At least four members of the committee must be present in order for the hearing to proceed.

Student-Athlete Health Care
WSU-ICAA Drug Education/Testing Program

 

At the hearing, the student-athlete will have the opportunity to present information that may refute the evidence of drug use or indicate mitigating circumstances. After hearing all the information, the committee will deliberate in private to make findings of the fact.  Then the findings and a recommendation will be provided in writing by the committee to the student-athlete and the Director of Athletics. The Director of Athletics shall have the final determination of the actions to be taken and will notify the committee and student-athlete of his or her final decision.

 

After reviewing this policy and signing a consent statement, any student-athlete who believes he or she has a substance abuse problem may discuss the problem with the Head Athletic Trainer. This notification must occur prior to the announcement of drug testing for that individual student-athlete or his or her team.  The consideration for admitting the problem is that only the Head Athletic Trainer and the student-athlete will be aware of the situation, and every reasonable effort will be made to maintain complete confidentiality.

 

 

Effects of Positive Test Results:

First Positive Test:  A student-athlete who has tested positive for the first time will be required to meet with their head coach and the Director of Athletics. Other action, as deemed appropriate by their head coach and/or Director of Athletics, including but not limited to informing parents and/or guardians, may be taken.

 

 

Second Positive Test:  A student-athlete who tests positive for a second time for prohibited use of drugs will be suspended from participation in intercollegiate athletic practice and competition for a specified time to be determined by the Director of Athletics. A student-athlete who has tested positive for the second time will be required to meet with their head coach and the Director of Athletics. Other action, as deemed appropriate by their head coach and/or Director of Athletics, including but not limited to informing parents and/or guardians, may be taken.

 

Third Positive Test:  Any student-athlete who has tested positive for the third time for prohibited use of drugs will be dismissed automatically from participating in intercollegiate athletics and will forfeit any future athletic aid at Wichita State University.

 

 

The number of positive tests is cumulative over the student-athlete's career.

(Policy Update 3/27/13)

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NCAA Drug Testing Policy

 

NCAA Drug Testing Program and Guidelines

 

Frequently Asked Questions - Year Round Drug Testing

 

Frequently Asked Questions - Championship Drug Testing

 

Frequently Asked Questions - Summer Drug Testing

 

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   WSU-ICAA Jewelry Policy

 

Jewelry Policy

 

Purpose

 

Wichita State University administration, athletic department, athletic trainers, and medical staff recognize the vital importance of student-athlete safety and medical welfare during participation in intercollegiate athletic practices and competitions.  Therefore, Wichita State University administration does not support the wearing of jewelry and other ornamentation (i.e. earlobe, nose, tongue, belly button, eyebrow, nipple, etc.) during the participation in intercollegiate athletics. Current studies have proven that the wearing of jewelry and other ornamentation during practice and/or participation poses a danger to the health and safety of the student-athlete and possibly to other teammates or opponents.

 

It is the intent of the University to restrict the wearing of jewelry and other ornamentation for participants in contact and partial-contact sports during all practices and competitions.

 

Those subject to the policy

 

All student-athletes are subject to compliance with this policy. A student-athlete is any participant on an intercollegiate squad, regardless of athletic financial assistance. All students who accept the privilege of participating in intercollegiate athletics for the university are subject to adhering to this policy. Those not complying with this policy may be subject to suspension and/or forfeiture of financial aid assistance.  Thank you in advance for your cooperation.

 

All student-athletes are required to read the above stated policy and sign the Policy Acknowledgement Form indicating that they understand it and are willing to comply with its provisions. 
 

(Updated 1/13/11)

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Policy Acknowledgment

 

Policy Acknowledgment

 

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  NCAA Policy for Sickle Cell Status Notification

 

The NCAA has recently made it mandatory for its member institutions to know the sickle cell status for all of its student-athletes. This must take place prior to participation in any athletic activity here at WSU. We urge you to have a Hemoglobin Electrophoresis test done prior to your arrival on campus and be able to produce proof of your test results. Failure to produce test results will delay your ability to participate in athletics here at WSU. Test results may take up to two weeks to get back.

 

WSU-ICAA Sickle Cell Memorandum

 

Sickle Cell Trait and the Athlete - National Athletic Trainers Association

 

Fact Sheet for the Student Athlete

 

Fact Sheet for the Coach

 

NCAA Sickle Cell Video

 

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NCAA Banned Drugs and Medical Exceptions Policy for ADHD 

 

The NCAA has recently made changes to the requirements for the medical exceptions policy for those student-athletes taking prescription stimulants for Attention Deficit Hyperactivity Disorder (ADHD). Any student-athlete who is taking prescription stimulants for ADHD must have formal testing and medical documentation in place in order to be eligible. The medical testing can take up to six months to complete so please refer to the following documents for further information:

 

2013-2014 Drug-Testing Exceptions Procedures (Medical exceptions) 

 

NCAA Physician Reporting Form

 

Adult Attention Deficit Hyperactivity Disorder (ADHD)
Sample Evaluation

 

Medical Case Documentation Case Examples

 

 

 

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 Student-Athletes Information Form signed by the policyholder. - 2 pages 

  Copy of medical, prescription, vision, and dental insurance cards.

 Medical History Questionnaire - 4 pages

Proof of immunizations for tetanus/diphtheria, measles, mumps, rubella, and Tuberculin prior to participation. Meningitis and Hepatitis B are recommended. (Only for freshman and New Student-Athletes )

Policy Acknowledgment signed by the student-athlete and parent or guardian. - 1 page  

 Hemoglobin Electrophoresis Test

 ADHD Formal Testing and Medical Documentation - If taking medication for ADHD

 

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Wichita State University administration, athletic department, and student-athletes recognize that drug abuse cannot be tolerated in the operation of or participation in intercollegiate athletics. It is known that the illegal use of drugs poses a danger to the health and safety of the users and possibly people associated with a user, such as teammates. Drug abuse also damages the integrity and reputation of all student-athletes, the institution, and the athletic department, and it undermines fairness in competition between individual student-athletes and between teams.