Student-Athlete Medical Information Forms

 

Health Insurance Information

All student-athletes must complete a Health Insurance Information / Authorization Form.

All student-athletes must submit a photocopy (front & back) of their health insurance card and their prescription benefits card.

The LA Tech Medical Care / Insurance Procedures for the Student-Athlete Brochure contains important information relating to insurance coverage of student-athletes, physician referrals, medical bills, etc. Please carefully read this document.

If a student-athlete's primary insurance coverage is through an HMO or managed care, the LA Tech Sports Medicine Department strongly encourages the student-athlete and/or his/her parent(s) / guardian(s) to change the primary care physician (PCP) to a LA Tech Team Physician or local physician in the Ruston, LA area. Changing your son's / daughter's PCP to a Ruston area physician will allow your son / daughter to have a network of physicians in the Ruston area, as well as avoid likely delays and/or an inability to receive medical care for athletic and non-athletic related injuries.

Any questions regarding LA Tech health insurance requirements should be directed to a member of the Sports Medicine Department.

Physical Examinations

Incoming Freshman, Transfer, and Walk-On student-athletes are required to complete a pre-participation physical examination prior to the student-athlete being issued equipment, being permitted to attend any practice or strength and conditioning session, and/or competing in any intercollegiate athletic activities.

Returning student-athletes who did not undergo a physical examination in May must undergo a physical examination prior to resuming any strength & conditioning session, practice, game, and/or competition. Physical examinations will be scheduled according to the individual teams report dates or on the first day of the Fall Quarter.

All physical examinations for LA Tech student-athletes must be completed by a LA Tech Team Physician.

If you are presently under the care of another physician for any chronic and/or recent injuries and/or illnesses, and/or if you have had any orthopedic or recent general medical surgeries, you must submit any operative and physician's notes and/or medical records related to the procedure(s) and submit a report and clearance on the physician's letterhead before you will be medically cleared to participate.

All physical examination requirements must be completed and on file in the LA Tech Sports Medicine Department BEFORE the student-athlete is permitted to participate in intercollegiate athletics at Louisiana Tech University.

The following forms must be completed prior to the physical examination:

Returning Student-Athlete Information

1. Returning Student-Athlete Welcome Letter(for your records)
2. Health Insurance Information / Authorization Form
3. Medical Care / Insurance Procedures for the Student-Athlete Brochure (for your records)
4. Medical Exams & Authorization Waiver
5. Health Privacy / HIPPA Consent Form
6. 2008-09 NCAA Banned Drug List (for your records)
7. Release of Medical Information Form

Incoming Freshman, Transfer, and Walk-On Student-Athlete Information
1. Incoming Freshman, Transfer and Walk-On Student-Athlete Welcome Letter (for your records)
2. Health History Questionnaire
3. Health Insurance Information / Authorization Form
4. Medical Care / Insurance Procedures for the Student-Athlete Brochure (for your records)
5. Medical Exams & Authorization Waiver
6. Health Privacy / HIPPA Consent Form
7. LA Tech Substance Abuse Policy (for your records)
8. 2008-09 NCAA Banned Drug List (for your records)
9. Release of Medical Information Form
10. Non-Scholarship / Walk-On Student Athlete Insurance Waiver (for your records)

Please return all information before WEDNESDAY, JULY 1ST to:

Louisiana Tech University Sports Medicine Department
1450 West Alabama Ave
Ruston, LA 71272

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