Athlete Medical Referral (click here to download)

    The Athlete Medical Referral form is a quick, convenient way for the doctor to provide all of the necessary information regarding diagnosis, treatments and limitations for injuries and illnesses that will affect an athletes' participation in athletics at HEHS.  The form is produced in quadruplicate and has two parts.  Part I is completed by the athletic training staff.  Signs, symptoms and immediate care are listed for comparison by the physician.  The suspected injury/illness is recorded also.  Part II is to be completed by the physician.  This includes specific diagnosis, period of restrictions, necessary treatments and rehabilitation, PE excuse (if needed), and a request for specific instructions.  Three parts of the form will be given to the student-athlete for completion.  The physician may keep one copy, and two copies are returned to the school (one for the nurse, one for the athletic training room).
    If the athlete does not have the triplicate form from the Athletic Training Room, a copy of the form may be downloaded from this site.  Simply click on the download button.  In this case, please complete the information at the top of the page (name, year, date, sport) and have the physician complete the bottom half of the form.  Have the student-athlete return the ORIGINAL copy of the note to the Athletic Training Room.

IHSA Skin Condition Evaluation and Authorization Form

(click here to download)

    This form, most specifically used with wrestlers, is  required prior to return to activity when a skin condition is present.  Examples of skin conditions include (but are not limited to):  ringworm, herpes, impetigo, eczema, and acne.  The form must be completed entirely, and is only valid for 14 calendar days.  If possible, the athlete should obtain a copy of the form from the Athletic Training Staff.
    If the athlete does not have the original form from the Athletic Training Room, a copy of the form may be downloaded from this site.  Simply click on the download button.  In this case, please print the athlete's name at the top of the page.  The physician must complete all 5 questions, as well as, sign and date the bottom of the page.  Completed, original forms should be returned to the Athletic Training Room.  Incomplete forms cannot be accepted. 
 

Additional Information
    If you have any questions regarding either of the forms mentioned above, please contact the Athletic Training Room Staff for assistance.  The direct telephone line is 847-755-5790.  If you reach the voice mail system, please leave a message, we will call you back.  The office is staffed Monday-Friday after 2:00 PM until all events are complete, and Saturdays from 7:00 AM until all events are complete.