Medical Clearance Procedures


First Time Participant Clearance Procedures

Download Printable (pdf) instructions and checklist here

Preseason Education and Notices
Please read all notices carefully prior to filling out any forms.  These notices are required to be read by the NCAA and institutional policies.  Download here: http://bit.ly/CCATSMnoticesV19.  You must be logged in to your Connecticut College Google Account to download.
  1. NCAA Concussion Fact Sheet for Student Athletes
  2. Mental Health Information Sheet
  3. Heat Illness/Hydration/Cold Injury Information Sheets
  4. Prescription Opioid Fact Sheet
  5. NCAA Sickle Cell Fact Sheet
  6. Sports Medicine Facility Rules and Regulations
  7. Emergency Action Plan Overview
  8. Privacy Notices

Forms
All forms should only be viewed and printed using Adobe Reader which can be downloaded for free at https://get.adobe.com/reader.  Other pdf readers do not preserve the formatting correctly. Additionally, all forms contain fillable fields so that you may type your answers and save the completed documents prior to printing.

All required forms can be downloaded here: http://bit.ly/ccatsm_forms_1st_years_rev2019

All forms must be scanned into a single document* and submitted via the online form at http://bit.ly/ccatsmwebportal by August 15th. We welcome earlier submissions! *You may download the free Adobe Scan Mobile App which allows you to use your mobile device’s camera to create a multipage pdf file if you do not have access to a scanner.

You must be logged into the Google account associated with your Connecticut College email address to access and submit forms.

Sports Medicine operates independently from and uses a different system than Student Health Services.  Please do not submit our forms via the Student Health Webportal. Be advised that the College also requires 1st Year and Transfer students to submit a separate Medical Clearance and Proof of Immunizations form via the Student Health Portal. Details can be found on the Student Health Center’s web page.

Incomplete or incorrectly completed forms will result in your medical clearance to participate in athletics to be delayed.  Please be sure to follow all directions carefully.

You must be at least 18 years old on the date that you sign any forms. If you are under 18 years old you must have your parent or guardian print and sign their name below your signature.

YOU WILL NOT RECEIVE ANY RECEIPT VERIFYING THAT WE HAVE RECEIVED YOUR SUBMISSION! You will only be contacted if your submission is incomplete or corrections need to be made.


Required Forms for 1st Year and Transfer Students

(All forms must be completed and submitted here: http://bit.ly/ccatsmwebportal by August 15th)

1. Preparticipation Health History Form
  • You must fill out this form on a computer or in ink and bring it to your primary care provider (physician/APRN) at the time of your physical exam.  
  • Your primary care provider must review the completed form.
  • You must thoroughly describe the details including the dates, duration, and disposition of any conditions where you checked “Yes."
  • You must sign and date the form (must sign by hand or use an Adobe Digital ID - DO NOT JUST TYPE YOUR NAME).
2. Preparticipation Physical Exam Form
  • Your primary care provider (physician/APRN) must complete this form at the time of your physical exam.
  • The form must be completed in its entirety.  All fields must be completed.  Incomplete forms will be rejected.
  • No substitute forms will be accepted.  
  • Physical Exams should be completed after April 1st.
    • By NCAA Rule and institutional policy, the exam date must not be earlier than 6 months prior to your 1st participation in athletic activity that is officially sanctioned by Connecticut College. Exams completed after April 1st should safely meet this requirement.

3. Sickle Cell Trait Testing Form
  • The NCAA and Connecticut College requires screening for Sickle Cell Trait.  You must submit a sickle cell solubility test lab report or a signed waiver prior to athletic participation. Student-athletes wishing to sign a release must engage in mandatory education regarding sickle cell trait. All newborns in the U.S. are screened for Sickle Cell Trait. You should be able to obtain a copy of this lab report from your pediatrician.
  • If you choose to sign the waiver you must have:
    1. Read the NCAA Sickle Cell Fact Sheet available at: http://fs.ncaa.org/Docs/health_safety/SickleCellTraitforSA.pdf.
    2. Viewed “Sickle Cell Trait and the Student-Athlete Parts 1 and 2” available at http://youtu.be/EiEpmZLLcuM and http://youtu.be/lbFWP39tF1A, respectively.

4. Assumption of Risk, Release & Waiver of Liability, Indemnity Agreement, Consent to Treat, and Acknowledgements Form
  • Fill out the fields on the top of the form.
  • Carefully review the information in the form
  • You must sign and date the form (must sign by hand or use an Adobe Digital ID - DO NOT JUST TYPE YOUR NAME).

5. Authorization for Release of Health Information
  • Fill out the fields on the top of the form.
  • Carefully review the information in the form
  • You must sign and date the form (must sign by hand or use an Adobe Digital ID - DO NOT JUST TYPE YOUR NAME).


Baseline Concussion Assessments

You must complete a computerized neurocogntive baseline exam as part of the medical clearance process for athletics at Connecticut College. This baseline will be recalled should you be examined for concussion throughout your collegiate athletics career.
You will be emailed a unique code directly from support@impacttestonline.com in August with the subject, "You've Been Assigned an ImPACT Baseline Test." so that you may complete the test at home.
Please take the test as soon as possible. You will not be allowed to participate with your team until you have completed this requirement. Things to Remember:
  • COMPLETE ALL SECTIONS! DO NOT SKIP DEMOGRAPHICS AND CONCUSSION HISTORY QUESTIONS!
    • DO NOT SKIP DEMOGRAPHICS AND CONCUSSION HISTORY QUESTIONS!
    • YOU WILL BE REQUIRED TO RE-TEST PRIOR TO PARTICIPATION IF YOU DO NOT COMPLETE ALL SECTIONS!
  • The test environment must be quiet and distraction-free without phones or other devices nearby.
  • Sit comfortably at a table or desk with a flat, hard surface.
  • Your computer must be plugged in to a wall outlet.
  • All other programs and browser tabs should be closed.
  • Pop-up blockers must be disabled.
  • An external mouse must be used...do not use your laptop's track pad.
  • You must complete the test in a single attempt in less than 45 minutes.
The Modified Balance Error Scoring System (mBESS) is also used to record baseline data for all incoming varsity student-athletes. You will be emailed as to when your testing session is scheduled.  You will not be allowed to participate in athletics until you complete the required testing.

If you receive a 403 Forbidden Error when downloading or submitting forms
  1. Make sure you are logged into your Connecticut College Google Account and try again.
  2. Clear your internet browser’s history and cookies, then log in to your Connecticut College Google Account and try again.
  3. Try a different web browser and then follow steps 1 and 2.


Returning Student-Athlete Clearance Procedures

Download Printable (pdf) instructions and checklist here

Preseason Education and Notices
Please read all notices carefully prior to filling out any forms.  These notices are required to be read by the NCAA and institutional policies.  Download here: http://bit.ly/CCATSMnoticesV19. You must be logged in to your Connecticut College Google Account to download.

  1. NCAA Concussion Fact Sheet for Student Athletes
  2. Mental Health Information Sheet
  3. Heat Illness/Hydration/Cold Injury Information Sheets
  4. Prescription Opioid Fact Sheet
  5. NCAA Sickle Cell Fact Sheet
  6. Sports Medicine Facility Rules and Regulations
  7. Emergency Action Plan Overview
  8. Privacy Notices

Forms
All forms should only be viewed and printed using Adobe Reader which can be downloaded for free at https://get.adobe.com/reader.  Other pdf readers do not preserve the formatting correctly. Additionally, all forms contain fillable fields so that you may type your answers and save the completed documents prior to printing.

All required forms can be downloaded here: http://bit.ly/ccatsm_forms_returners_rev19

All forms must be scanned into a single document* and submitted via the online form at http://bit.ly/ccatsmwebportal by August 15th. We welcome earlier submissions! *You may download the free Adobe Scan Mobile App which allows you to use your mobile device’s camera to create a multipage pdf file if you do not have access to a scanner.

You must be logged into the Google account associated with your Connecticut College email address to access and submit forms.

Sports Medicine operates independently from and uses a different system than Student Health Services.  Please do not submit our forms via the Student Health Webportal.

Incomplete or incorrectly completed forms will result in your medical clearance to participate in athletics to be delayed.  Please be sure to follow all directions carefully.

YOU WILL NOT RECEIVE ANY RECEIPT VERIFYING THAT WE HAVE RECEIVED YOUR SUBMISSION!  You will only be contacted if your submission is incomplete or corrections need to be made.

Required Forms for Returning Student-Athletes

(All forms must be completed and submitted here: http://bit.ly/ccatsmwebportal by August 15th)

1. Preparticipation Health History Annual Follow Up Form
  • Complete this form on a computer or in ink. 
  • You must thoroughly describe the details including the dates, duration, and disposition of any conditions where you checked “Yes."
  • You must sign and date the form (must sign by hand or use an Adobe Digital ID - DO NOT JUST TYPE YOUR NAME).
2. Annual Preparticipation Blood Pressure & Heart Rate Measurement
  • Your primary care provider (physician/nurse practitioner) should
    complete this form at the time of your annual physical exam.
  • You must submit a note from your physician or
    nurse practitioner clearing you for intercollegiate sports
    participation if:
    • your systolic pressure (top number) is 140 mmHg or higher AND/OR
    • your diastolic pressure (bottom number) is 90 mmHg or higher
  • Blood pressure measurements should be completed after April 1st.
    • By NCAA Rule and institutional policy, the exam date must not be earlier than 6 months prior to your 1st participation in athletic activity that is officially sanctioned by Connecticut College. Exams completed after April 1st should safely meet this requirement.

3. Assumption of Risk, Release & Waiver of Liability, Indemnity Agreement, Consent to Treat, and Acknowledgements Form

  • Fill out the fields on the top of the form.
  • Carefully review the information in the form
  • You must sign and date the form (must sign by hand or use an Adobe Digital ID - DO NOT JUST TYPE YOUR NAME).

4. Authorization for Release of Health Information
  • Fill out the fields on the top of the form.
  • Carefully review the information in the form
  • You must sign and date the form (must sign by hand or use an Adobe Digital ID - DO NOT JUST TYPE YOUR NAME).


If you receive a 403 Forbidden Error when downloading or submitting forms
  1. Make sure you are logged into your Connecticut College Google Account and try again.
  2. Clear your internet browser’s history and cookies, then log in to your Connecticut College Google Account and try again.
  3. Try a different web browser and then follow steps 1 and 2.


Medical Clearance Following Injury 
or Medical Condition



Injured student-athletes are returned to sport following graduated return-to-play paradigms as their level of function and pain levels allow.  It is our goal to return our student-athletes to sport in a safe manner that decreases the likelihood of re-injury and preserves their long-term quality of life.

Any student-athlete that has seen a physician regarding an injury or other medical condition that is beyond the scope of athletic training as defined by professional best practices, State statutes, and Physician Standing Orders must provide the Director of Sports Medicine or their designee with a written medical clearance note from the attending physician prior to returning to any physical activity associated with College sanctioned intercollegiate athletics. This note must reference the condition for which they were seen, and state that they are cleared for full participation or detail any restrictions that should be adhered to.

Our staff will provide a blank copy of our clearance form to any student-athlete that we refer for outside care.  We instruct student-athletes to bring the form with them to their appointment for the physician to complete. The student-athlete must return the completed form or other acceptable correspondence from the physician, as described above, to us prior to resuming activity, and then must only return as directed by the physician’s note.

If time-sensitive, a verbal clearance delivered directly from the attending physician to a member of the sports medicine staff is acceptable provided that we are able to confirm the physician’s identity and qualifications.  We will document the following in the patient’s chart: The physician’s name, the terms of the clearance as described above, the date and time of the communication, and the means of communication (in-person, phone, etc.). The verbal communication should be followed by a written clearance within 2 days. If a written follow-up is not obtained in 2 days, the student-athlete will be removed from play until it is received.

As always, the team physician or his designees (our Sports Medicine providers) have the final authority to clear or withhold a student-athlete from play. If we are not in agreement with a medical clearance note from an outside provider we may continue to withhold that student-athlete from play and refer them to the team physician for a final decision regarding their clearance status.