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NEW Athlete Pre-Participation Checklist

CLICK HERE TO DOWNLOAD THIS PAGE IN WORD FORMAT

In order to compete in varsity athletics at R-MC you must complete the following items BEFORE AUGUST 1: (Athlete should complete these forms, not the parent)

Complete your Randolph-Macon College Athletic Pre-participation Physical (pages 3-4). As a New Athlete at R-MC be sure to have your doctor complete the section for New NCAA athletes that includes verifying your sickle cell status. You were tested at birth and should not need a new blood test.

  • Upload your completed physical to ATS, directions on page 2.                  

Login to ATS (DO NOT USE INTERNET EXPLORER) at the following link: https://www.atsusers.com/ATSWeb/login.aspx?ReturnUrl=%2fatsweb%2fdefault.aspx

Initially to sign in use “new” as your athlete ID, “new” as your password, and ATSRMC as the database.  Once you are in the portal, fill out all required fields and click save. Be sure to create a new ID (please use your student ID if you know it) and new Password.  Additional tabs will become available and you will need to fill out information under the following sections:

  • Insurance (ALL STUDENTS SHOULD HAVE PRIMARY INSURANCE)
    • Upload a picture of your insurance card, front and back. IMAGE MUST NOT EXCEED 1MB
  • Contacts
  • Forms
    • Next to form name use the dropdown menu to select each form. Then Click NEW. You must complete ALL forms. The forms include:
      • HIPAA
      • NCAA Video Sample
      • Permission to treat
      • Acceptance of risk
      • Permission for Release of Medical Records
      • Pre-Participation
      • Insurance Statement

***BE SURE TO CLICK SAVE AFTER COMPLETING EACH FORM

*when signing in the box use your mouse to draw out your name, then type your name in the text box, then click save

If you are currently prescribed ADD/ADHD medications for a diagnosed condition you must have your prescribing physician fill out the following form, this form MUST have attached documentation as indicated on the form. 

http://www.rmcathletics.com/information/adhd.pdf

  • Upload this form and attached documentation into ATS, directions below

 

How To Upload Your Documents to ATS

 

  1. Log into ATS using your new ID and PW that you created (see New Athlete Pre-Participation Checklist if you have not yet completed this step)
  2. Choose “Athlete Information”
  3. Choose the “eFiles” tab
  4. Type in a description (ie adhd documentation 2017)
  5. Choose the file type from the dropdown menu, if nothing applies, choose “other form”.
  6. Choose your file
  7. Click UPLOAD

 

*PLEASE NOTE, DOCUMENTS MUST NOT BE LARGER THAN 1MB. If it is, compress it and try again.

 

  

Randolph-Macon College Athletic Pre-Participation Form

 

 

Name:_____________________________   Age:__________   Date of Birth:_______________ 

 

Sport(s):_____________________________________________________________________

 

PHYSICAL EXAMINATION                                             Date of Examination: _______________

 

Sex: ☐ Male   ☐ Female           Height:____________   Weight:____________  

 

BP:__________ Pulse:________ Temp:________   Vision: R_20/______  L_20/______   Corrected: Y  N

 

MEDICAL

Normal

Abnormal Findings

Appearance             (Marfan stigmata: kyphoscoliosis, high-arched palate, pectus

                                                                 excavatum, arm span > height, hyperlaxity, myopia)

 

 

Eyes/Ears/Nose/Mouth/Throat

 

 

Heart                         (Auscultation standing and supine +/- valsalva, Location of PMI)

 

 

Pulses

 

 

Lungs

 

 

Abdomen

 

 

Genitourinary (males only)

 

 

Lymph nodes

 

 

Skin          (HSV lesions, MRSA lesions, tinea corporis)

 

 

Neurologic including reflexes

 

 

MUSCKULOSKELETAL

Normal

Abnormal Findings

Neck

 

 

Back

 

 

Shoulders

 

 

Elbows

 

 

Wrists and Hands

 

 

Hips

 

 

Knees

 

 

Ankles and Feet

 

 

Functional

 

 

Randolph-Macon College Athletic Pre-Participation Physical Form

 

Name:_______________________________________  Date of Birth:____________________

 

Recommended (optional) labs: Hgb:_______   HCT:______   Vitamin D:________

 

NEW STUDENT-ATHLETES ONLY: NCAA Requirement

At the recommendation of the NCAA, Randolph-Macon College requires that all intercollegiate athletes must verify their sickle cell trait status prior to participation in a sport without regard to risk factors. Athletes will be unable to participate without this verification.

 

Date of Sickle Cell Testing:____________    ☐ POSITIVE Sickle cell trait  ☐ NEGATIVE Sickle cell trait

                                                                       ☐ POSITIVE Sickle cell disease 

 

Comments on Physical Examination and Labs:

 

 

 

ATHLETIC PARTICIPATION STATUS:

I have reviewed the data above, reviewed his/her medical history, and make the following recommendations for his/her participation:

 

☐ Cleared for ALL athletic activity without restriction.

 

☐ Cleared for ALL athletic activity without restriction with recommendations for further

 

evaluation or treatment for ______________________________________________________.

 

☐ Not cleared:

            ☐ Pending further evaluation for ____________________________________________.

            ☐ For any sports.

            ☐ For certain sports including ______________________________________________.

 

Reason(s) for non-clearance:

 

 

 

By this signature, I attest that I have examined the above student athlete and completed this pre-participation physical examination.

 

Physician Signature: _________________________________________ Date: _____________

 

Examiner’s Name and degree (print): ______________________________________________

 

Address: _____________________________

_____________________________________

_____________________________________

 

Phone:_______________________________

Fax: _________________________________

(Office Stamp)

Only signatures of Doctor of Medicine, Doctor of Osteopathic Medicine, Nurse Practitioner or Physician’s Assistant licensed to practice in the United States will be accepted.