All Pitt-Johnstown student athletes are required to complete the necessary paperwork before each academic year to be eligible to compete at the NCAA level. All students are required to complete the Physical, Insurance, and Medical Profile forms annually. Also, Sickle Cell Solubility Test results must be turned by all freshman/first year and transfer student athletes, before participation. You can obtain results by obtaining a new test from your primary care physician or contacting the Department of Health of your respected state of birth to determine if you had a Sickle Cell Solubility Test at birth. All first year student athlete’s physical must be completed by a physician. Physicals will not be done on campus. It is your responsibility to get a physical before returning to campus. The University is not responsible for any fees involved with physicals and other medical visits and/or testing required for clearance to participate. After your physical is completed, I highly recommend taking a clear picture of the completed form, as a backup copy. This is the only form that cannot be filled out on campus. The Physical, Insurance, and Medical Profile forms can be found in the links below. Neurocognitive testing will be done on campus during a team meeting. You will be given instructions once you return regarding downloading the app and when your team will be tested. Athletes may not participate in try-outs, strength and conditioning sessions, practices, or competitions until all testing and paperwork is completed correctly, and on file in the Athletic Training Department. The Athletic Training Staff has the right to delay participation if they feel further medical testing or documentation is needed for any reason.
The UPJ Athletic Department will provide coverage for medical expenses, performed by physicians and dentists, to student athletes sustaining new injuries during official supervised practices and contests only. Pre-existing injuries and chronic conditions may not be covered. You must contact the Athletic Trainers before receiving medical care, unless it is an emergency. The University requires the student-athlete use his/her personal insurance as a primary insurance, and the University’s insurance will cover the unpaid portion. Because the medical bills will be processed through your insurance company first, you will receive all notices and bills at your home. It is the patient’s responsibility to provide the insurance company with any requested documents necessary to complete the claim. See Secondary Insurance Claim Information for Athletic Injuries document below for insurance company information.
The University’s insurance does not cover all procedures or expenses. Please check with the athletic training staff prior to any visit to determine if the service will be covered. If you are required to pay a co-pay at the time of service, please ask for an itemized receipt, with the patient’s name and form of payment, and you can submit it for reimbursement through the insurance company. Itemized bills and Explanation/Statement of Benefits may be necessary to process the insurance claim. It is the patient’s responsibility to provide any documentation the school’s insurance company requests to process bills. Also, if a prescription required, keep the receipt and the drug name/description information page that is typically stapled with the receipt. We will need both documents to reimburse you. If any money is paid out of pocket, a receipt of service and proof of payment (i.e. copy of a check or email confirmation of credit card payment) will be necessary for reimbursement. The University will cover any expenses up to one year after the date of service. Delay of submitting bills may result in non-payment. Always consult a member of the athletic training staff for approval prior to seeking out services off campus, or these bills may not be covered, except in an emergency situation.
All illnesses and physical injuries not directly related to supervised NCAA practice or contest are not covered by the school’s insurance. Students can receive care for general medical conditions, on campus, at Health Services, located in the Student Union, office G-10. This location also provides counseling services for students who may have mental health concerns for themselves or others.
Required forms:
Freshman/ First Year/ Transfers : Physical completed by MD/ DO, Insurance, Medical Profile, Sickle Cell Solubility Test results
Sophomore/Junior/ Senior: Physical completed by MD/ DO/ CRNP/ PA, Insurance, Medical Profile
You may request a hard copy of all of the forms necessary to participate by emailing your name and mailing address to rrm60@pitt.edu.
Head Athletic Trainer Assistant Athletic Trainer
Elissa Till MS, ATC/LAT, PES, CES Rick May ATC/LAT, PTA
(814) 269-2024 (814) 269-1935
Fax (814) 269-2026 Fax (814) 269-2026
till@pitt.edu rrm60@pitt.edu
ATHLETIC TRAINING DOCUMENTS AND FORMS
Physical Form
Insurance Form
Medical Profile
Secondary Insurance Claim Information for Athletic Injuries
BASELINE CONCUSSION TESTING WILL BE DONE ON CAMPUS.
