Contra Costa Comets Athletics

WELCOME TO CONTRA COSTA COLLEGE ATHLETICS

Athletic Health Packet

Assumption of Risk and Waiver Liability

Consent to Treat

Emergency Contact

Football Helmet Waiver

Insurnace Forms

KAISER ONLY HIPPA Release

Minor Consent to Treat

NAHGA Claim Process and Referral Form

Physical and Med History

CCC Athletics packet 2020-21

Concussion acknowledgement form (athlete)

Concussion acknowledgement form (coach-staff)

Concussion Fact Sheet

Concussion Information take home

Concussion Management Policy

Environmental Considerations

Return to Learn Protocol

Return to Play Protocol

SCAT5 SYMPTOM EVALUATION

Medical Clearance Process for Student Athletes:

1 . Enroll in Class for Sport (get assistance from coach/counselor, medical documents can still be completed prior to enrollment)

  1. 2. Download Band App and obtain QR code from Coach
  1. A. Team information (frequent notifications)
  2. B. Main communication with team, coaches, and athletic trainer
  3. C. Send Athletic Trainer direct message with the following (Healthy Roster Access):
    • > Full name
    • > Phone number
    • > Email (parents email if a minor)
    • > Birthdate

3. Download Healthy Roster App (all medical documents)

  1. A. Check email from athletic trainer for access code for Healthy Roster
  2. B. Use code to create account
  3. C. Create profile with all personal information and upload headshot photo.
  4. D. Go to Documents tab and complete ALL “missing documents”. Download PDF fillable templates for each required document complete and sign (actual signature required)

  • > Athletic Authorization to Release Medical Information (HIPPA)
  • > CCC Assumption of Risk and Waiver Liability for Sport
  • > Consent to Treat (if a minor, parent/guardian must complete Minor Consent to Treat)
  • > Emergency Contact
  • > Insurance Card (upload copy of insurance card)
  • > Insurance Forms (if you have Kaiser, please compete Kaiser only HIPPA release)
  • > Helmet waiver (Football only)
  • > Physical and Medical History 22-23
  •                                           1.    Get physical from MD or DO. WILL NOT ACCPET ANY
                                               physicals from Chiropractors, FNP, NPs, & PA-C

    2.    Complete
    Medical history form prior to taking your physical to your physician

      > ·  COVID-19 Forms:

·        Vaccination Card (upload copy of COVID vaccination)

·        Contra Costa College COVID Assumption of Risk

·        Contra Costa College COVID Pre-Participation Questionnaire

·        COVID-19 Test result (copy of test 5 days prior to arriving to CCC)

***Free testing available on campus, please see athletic trainer for registration***

4. Concussion Testing (two separate testing platforms are required!) will be held in-person with the team on scheduled date:

A. SWAY medical: (1 of 2) to be completed on phone via app. Code will be provided upon request (during testing). Please follow this link for directions      https://youtu.be/Dv6tVfRiwwU

B. ImPACT concussion test: (2 of2) To be completed on Desktop or Laptop. CANNOT BE COMPLETE ON CELL PHONE OR TABLET. A code will be provided upon request (during testing). Follow directions and “enter additional demographics” (do not skip). Notify Athletic Trainer when completed.

Please direct any questions regarding medical forms or procedures to the Athletic Trainer.