Step 7:

Health Information Checklist

COLLEGE

Health Center / Athletic Department:

Health Information Checklist

ALL NEW AND RETURING STUDENTS ARE REQUIRED TO COMPLETE. NO EXCEPTIONS


Consent for Medical Treatment – signed by Student* via DocuSign

Insurance Information and Copy of Cards – signed by Student* and provided via DocuSign upload, fax or e-mail

Medication Management – signed by Student* DocuSign

Medical History (Health Center) – signed by Student* (share with Physician) and provided via DocuSign upload, fax or e-mail**

History Form – signed by Student* (share with Physician) and provided via DocuSign upload, fax or e-mail**

Athlete with Special Needs – signed by Student* and provided via DocuSign upload, fax or e-mail**

Concussion Information and Consent – signed by Student* via DocuSign

Acceptance of Risk / Authorization for Training Room – signed by Student* via DocuSign

Notice of Privacy Practices – signed by Student* via DocuSign

Waiver and Release of All Claims / Assumption of Risk – signed by Student* via DocuSign

Immunization Record – signed by Physician and provided via Docusign upload, fax or e-mail**

Clearance Form – signed by Physician and provided via Docusign upload, fax or e-mail**

Physical Exam Form – signed by Physician (and completed AFTER May 31, 2018) and provided via Docusign upload, fax or e-mail**

Consent for Medical Treatment – signed by Student* via DocuSign


* Documents requiring a physician's signature may be brought with the cadet to orientation or as late as check-in. No cadet will be permitted to move in without these completed documents, therefore it is strongly suggested that the documents be submitted electronically prior to move-in.


This packet of paperwork can be faxed, scanned and emailed to the Heath Center or Athletic Department, or handed in during check-in. We suggest you retain a copy for your records. If you have any questions, please feel free to contact us at the information list below.

Deborah Hammer, R.N. Alyson Winther, MS, LAT, ATC

Health Services Department Athletic Department

Email: Dhammer@vfmac.edu Email: Awinther@vfmac.edu

Phone: 610-989-1518 Phone: 610-989-1495

Fax: 610-989-1516 Fax: 610-989-1496

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