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Dear Student-Athletes and Parents, Indiana University Southeast is pleased to have you as a part of the Indiana University Southeast Athletic Program. On behalf of the sports medicine team at Indiana University Southeast
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Document Date: 2014-07-16 10:16:52

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City

New Albany / /

Company

BP / Indiana University Risk Management / KORT / Primary Care Physician Group / /

Country

Italy / United States / /

Facility

University Southeast Declaration / University Southeast Athletic Program / University Southeast Athletic Department Website / University Southeast Athletics Department / The University / University Southeast Athletic Bills The Indiana University Southeast Department / University Southeast Intercollegiate Athletics Department’s / University Southeast Athletic Department / University Southeast Department / Indiana University / University Southeast Athletic Injury Handbook / University Southeast / /

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IndustryTerm

low energy / insurance reimbursement / insurance / tobacco products / above health insurance information / media relations / medical/diagnostic services / web-site / collectible group insurance benefits / insurance carriers / media such materials / care of the injury/illness / insurance information form / /

MedicalCondition

loss of consciousness / sickle-cell anemia / scar / injury/illness / ventricular tachycardia / Hypertrophic Cardiomyopathy / athletic injury/illness / Headaches / chest pain / Seizures / flu / brain injury / Allergies/Asthma / non-medical allergies / Nausea/vomiting / Nausea / Unusual fatigue / greater injury / Sudden Cardiac Arrest / Fatigue / Drowsiness / brain injuries / injury / infection/inflammation / disorder / scarlet fever / hepatitis / Fainting/blackouts / illness / MS / Myocarditis / Neck pain / blindness / head injury / asthma / Long QT Syndrome / pain in your back / Arrhythmogenic Right Ventricular Cardiomyopathy / Disease / aches / Shortness of breath / Amnesia / severe brain swelling / sickness / shoulder injury / vomiting / Non-Compaction Cardiomyopathy / Marfan Syndrome / Neck Injuries / rheumatic fever / Wolff-Parkinson-White Syndrome / medical allergies / epilepsy / epileptic seizure / head injuries / viral pneumonia / high blood pressure / infectious mononucleosis / dizziness / athletic injuries / infectious disease / injuries / Marfan’s Syndrome / e.g. heat stroke / /

MedicalTreatment

surgery / /

Organization

KIAC / IU Southeast Athletic Department / Indiana University Southeast Department of Athletics / Athletics Department / Indiana University Southeast / National Association of Intercollegiate Athletics / Indiana University Southeast Department of Athletics Health Examination Form Name / /

Person

Athletic Trainer / Tiffany Hammond / /

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Position

Athletic Director / Physician / Team Physician / student-athlete / ATHLETE / coach / representative / Authorization Student-Athlete / Private / Signature Date Student-Athlete / ATC Head / Head / /

Product

Performance-Enhancing Drug / /

ProvinceOrState

Indiana / /

Technology

sports medicine / /

URL

www.iusathletics.com / http /

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