Athletic Medical History Form
OU Athlete Physical Form
Dear Ottawa University Student Athletes and Parents,
As we are wrapping up a very successful year of athletics at Ottawa University, we are getting excited for another good year in 2010-2011. It is very important to us that we provide you with the best medical care possible so that you can be a contributor to your team and to another successful year for Ottawa Braves Athletics. Our desired quality of care is based on several key factors:
1. Obtain a thorough medical history, physical exam, and orthopedic screening. This allows us to make sure that you are healthy and ready to play, and lets us identify, prevent and prepare for potential problems before they arise.
2. Obtain current insurance and emergency contact information. This allows us to work quickly when you are injured to get you checked by medical professionals, get MRIs and x-rays, contact someone to let them know you are injured, and start the process of filing insurance claims.
3. Maintain a well trained, equipped and accessible sports medicine team to serve you. As a staff, we take pride in continually learning the best methods of treatment available.
We are always looking for ways to improve our emergency equipment. We maintain a close working relationship with Dr. Greg Lynch and Dr. John Gollier to take care of your orthopedic and general medical concerns. We try to maximize our availability to student athletes with consistent training room hours, home contest coverage and travel with teams. We work closely with Kathy Hinderliter who handles all of our secondary athletic insurance claims.
In order to best serve you, we need you to complete the checklist of items listed below and return all forms to us by AUGUST 1st, 2010. This deadline is necessary so that we can correctly screen and process all information before the start of fall sports. Any athlete, regardless of sport, who does not have the checklist completed and information returned to us by AUGUST 1st, 2010 is not guaranteed to be cleared to start their respective sport season. Winter and spring athletes need to complete this process as well by AUGUST 1st, 2010 because once the fall sports pre season starts, we are very limited in time to process this required information.
- Complete the Athlete Medical History Form
- Get an athletic physical exam and submit it on the OU Athlete Physical Form (Physical must be completed by an MD or DO only. Physicals completed by other health care professionals will not be accepted.)
- Submit a clear photocopy of both sides of all primary insurance cards
- Complete an orthopedic screening with the OU Sports Medicine Staff (We will have two dates in July that students can complete these or one date during Fall Orientation Weekend in August. Please try to attend one of the July dates to ease the numbers at the Orientation time in August)
The Athlete Medical History Form and OU Athlete Physical Form can be found and printed at www.ottawabraves.com on the Sports Medicine links on each sports page or under Inside Athletics on the Sports Medicine link. You may type your answers into the Medical History Form and then print it off or print it and complete it legibly by hand. Both forms and your insurance card can be submitted before August 1st, 2010 by email to jennifer.raybern@ottawa.edu, by fax to (785)229-1015 or mailed to
Ottawa University Attn: Jennifer Raybern 1001 S. Cedar St. #7 Ottawa, KS 66067.
We look forward to working with you this year. If you have any questions please feel free to email us or call us and we will try to answer your questions in a timely manner.
Sincerely,
Jennifer Raybern MS, ATC, CSCS, PES 785-242-5200 Ext 5427 Christopher Poskey MS, ATC, CES
Head Athletic Trainer Assistant Athletic Trainer
jennifer.raybern@ottawa.edu chris.poskey@ottawa.edu