Available Form Templates

Updated by Niki Budd

Available Form Builder Templates

Within the form builder we have created standard forms that you can further customize to suit your needs with the hope of speeding up the creation of your forms. These forms are available to provider users as a template.

We recommend testing the form on a test patient prior to using it in a live environment
Please note we generalized these templates, ensure you are editing/removing all fields where we input a callout ex: [INSERT SCHOOL NAME HERE]

Pre-Participation:

Parent/Legal Guardian document intended to release the parent from signing all required document with Student Athlete at the same time

Athletic Insurance Questionnaire

Student Athlete Insurance Information

AUDIT Alcohol Screening Tool

The AUDIT (Alcohol Use Disorders Identification Test) is an effective and reliable screening tool for detecting risky and harmful drinking patterns

ADHD Medical Exceptions Notifications Form

The NCAA Medical Exception Documentation Reporting Form to Support the Diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) and Treatment with Banned Stimulant Medication.

Assumption of Risk

This form is an assumption of risk, release, and waiver of liability, and consent is used for participants in athletics.

Authorization to Obtain & Release Medical Information

This form is used to receive authorization to obtain and release medical information.

Combined Medical History-Incoming/Returner

Medical History document that is specific to subset groups in one document. Returners will complete the “Returning Student Athlete Physical” and incoming athletes will complete the “Incoming Detailed Medical History”

Concussion Awareness Form

Information for Student-Athletes and Parent/Guardians. Contains educational info and allows both athlete and parent/guardian to sign in agreement to show that they have received and agree to the information.

The consent to treat form gives providers permission to treat their child when he or she is in someone else's care.

Detailed Student Athlete Medical History Questionnaire

A comprehensive medical history questionnaire, intended for initial intake of medical history.

HIPAA Release Form

This form is used to obtain consent from a patient before their protected health information can be shared for non-standard purposes

2023 NCAA Concussion Fact Sheet for Student Athletes

Fact Sheet for Student Athletes to read and sign

NCAA Sickle Cell Trait Fact Sheet (2024)

NCAA Sickle Cell Trait Fact Sheet

Insurance Information

Collection of Insurance Information

Preparticipation Physical Evaluation

Preparticipation Physical Evaluation with biometric, vision, MSK, and Medical Review. To be completed via Physician.

Returning Student Athlete Physical

This form is to be with returning student-athletes who are required to complete a Medical History Update Form.

Sickle Cell Information and Documentation

NCAA Sickle Cell Trait Testing Information Form - allows students to request one of 3 options: 1) Sickle Cell Trait Testing 2) Agree to Provide Proof of Prior Testing 3) Elect to Not Proceed with testing

Student-Athlete Demographics & Emergency Contact Form

This template gathers basic information of the student-athlete which includes address, medical insurance information, and emergency contact information.

The purpose of this document is to acknowledge drug education training and outline consent to drug testing

Wellness:

A.D.I.M.E Note

RD and RDN standard dictation. Document is intended to ensure high quality care to patients and clients with nutritional needs.

General Screening Index

This template gathers information about a student-athlete's mental well-being.

Return-To-Play Daily Progression

Daily documentation for concussion return to play monitoring

Wellness Survey

Universal Wellness Survey - checking everything wellness for inside and outside school and sports

Cranial Nerve Testing

Standard recording of Cranial Nerve Testing for providers

Daily concussion Symptom checklist

Daily symptom checklist, follows SCAT5 checklist (with calculated values)

Patient Reported Outcomes:

These templates are outlined within the helpdoc: Form Builder Templates with Pre-Calculated Values


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