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CLEVELAND STATE ATHLETIC TRAINING ROOM
Staff:
TBA, Head Athletic Trainer
Jackie Wise, Associate Athletic Trainer (j.wise@csuohio.edu)
Kelley Becker, Assistant Athletic Trainer (k.a.becker@csuohio.edu)
Chris Higgins, Graduate Assistant (c.w.higgins@csuohio.edu)
Hours:
CSU Convocation Center (1st Floor): 8:00 a.m. - 5:00 p.m.
Woodling Gymnasium (PE SB6): 8:00 a.m. - 5:00 p.m.
Phone/Fax Information:
CSU Convocation Center: (216) 687-5287 (P)/(216) 523-7257 (F)
Woodling Gymnasium (216) 687-4806 (P)/(216) 687-9242 (F)
Policy and Procedures for Student-Athletes
The Cleveland State University Athletic Training Department would like to take this opportunity to welcome you to the CSU athletic team. As athletic trainers we would like to provide the best care for you as a student-athlete here at this institution. To do so, we need your cooperation in providing us with detailed information regarding your insurance coverage and medical history. All information is confidential and is necessary to provide the best care possible and to allow you to compete for the university. Thank you for your cooperation.
Below you will find various forms that must be filled out completely and signed by both the student-athlete and their parent or guardian. Please return all forms in the envelope provided by July 31, 2004. These forms are needed before a pre-participation physical can be administered.
Complete Packet in PDF Format
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I. Insurance Questionnaire
A. Parent/Self Insured
Please fill out the insurance questionnaire form completely with all insurance information. This information can be taken off of most insurance cards. Please make a copy front and back of both the insurance card and the prescription card, if applicable.
B. Cleveland State University Health Plan
Please state CSU Insurance next to “Name of Insurance Co.” if you are covered by this policy. Complete the rest of the form and make a copy of the card front and back.
C. No Insurance
Please state “No Insurance” next to “Name of Insurance Co.” if this applies to you. It is strongly suggested that each student have some form of insurance. A student may purchase CSU insurance for a small semester/annual fee. Such information on this topic can be obtained from the athletic training room at (216) 687-4806.
II. Medical History
Please complete the front and back of this form including the immunization information. Also, if you marked “YES” for any of the questions, make sure you go into detail and explain the injury or illness. If the athlete has had any serious injury or illness, we would like for you to include or bring any documentation/reports from physicians to be reviewed by our team physicians and then kept in your medical file. All information is needed to ensure that the athlete has a complete and thorough physical examination and to forgo any future problems or occurrences.
III. Authorization to Release Medical Information
Please read the bottom paragraph and then complete the above portion including the signature.
Frequently Asked Questions
A. If an injury were to occur to an athlete, how would the bills for their care be paid for?
CSU team physicians, associated with the Cleveland Clinic, visit the university twice a week to check on athletes and their injuries or illnesses. If further medical attention is needed (i.e. X-rays, MRI, visit to a specialist) the bills from such a visit will be first submitted to the athletes primary insurance followed by their secondary, if applicable. Remaining balances or services not covered by the insurance company will be submitted to the CSU insurance company. To do so, an explanation of benefits form from your insurance company needs to be sent to us with any unpaid bills. The remaining balances will be paid for by CSU. To help us with the payment of all bills, if you receive any bills that your insurance company will not cover, please send them to us immediately so they may be taken care of.
B. What types of injuries are covered by CSU?
As per NCAA rules, Cleveland State’s athletic injury insurance will not cover any non-athletic related injury/illness. This includes but is not limited to routine dental exams, eye exams or OBGYN appointments. We will however cover any injuries sustained while participating in intercollegiate practices or competitions.
C. What happens if an athlete has a pre-existing injury/illness?
Pre-existing injury/illness will not be covered by CSU unless an injury reoccurs while the athlete is participating in an intercollegiate practice or competition.
D. Does CSU cover any prescriptions that an athlete may need or are currently taking?
If a CSU team physician prescribes an athlete medication, the cost will be covered first by their prescription plan, if applicable. If the athlete does not have a prescription plan, CSU will cover the cost of the prescription. Any pre-existing prescriptions being taken by an athlete (i.e. acne medications, birth control) will not be paid for by the university.
E. What if the athlete, or family member, prefers to seek medical care other than that provided by CSU or the Cleveland Clinic and their physicians?
CSU will assume NO financial responsibility for the care received by anyone other than those associated with CSU. Our staff will tender no follow-up care for the athlete and once cleared by their treating physician, then the athlete will only be allowed to participate in their intercollegiate activity once they are given medical clearance by a CSU team physician.
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