Dear Student Athlete and Parent,

Welcome to Morningside College and Morningside Athletics. We are excited to have

you participating in intercollegiate athletics at Morningside College.

We have placed the athletic forms needed for the Athletic Training Room Staff online.
You will find these forms under the student insurance link on the Athletics website. This
is need strictly for your participation in athletics; it is separate from the student health
paperwork. Included in this packet are as follows:
Personal Data Health History or Health Status Review
Proof of Insurance Assumption of Risk
Pre-existing Conditions Release & Waiver
Substance Abuse Testing Insurance Coverage Information
Referral Policy Sports Medicine Provider Information

All the forms need to be filled out entirely, signed, and returned to the Athletic Training
Room Staff by July 16, 2010, via mail or hand delivery, email submission will not be
accepted. Please send the completed forms to:
Morningside College
Athletic Training
1501 Morningside Ave.
Sioux City, IA 51106

If you have any questions about these forms, the insurance coverage information or the
referral policy information please contact the Athletic Training Room Staff at 712-274-
5314 (Greg).

We look forward to working with you during your intercollegiate athletic career at
Morningside College.

Sincerely,
Greg Seier
Head Athletic Trainer
INTERCOLLEGIATE ATHLETICS MORNINGSIDE COLLEGE
PERSONAL DATA ATHLETIC TRAINING
2010-2011

Student Athlete Information: Parent/Guardian Information:

Name ________________________ Name(s)

__________________
First MI Last

SS# ________________________ Relationship

__________________

Date of Birth ________________________ Home Address

__________________

Local Phone # ( )____________________ City, State, Zip

__________________

Cell Phone # ________________________ Home Phone # ( )_____________

Sport(s) ________________________ Work Phone # ( )_____________

________________________ Emergency Contact

__________________
Year in School 1st 2nd 3rd 4th 5th
(Circle One) Emergency Phone # ( )_____________

Family Physician ________________________________________( )_____________

Name City State Phone #
Are You Allergic To:
Type Circle One Explanation
PENICILLIN YES NO
SULFA DRUGS YES NO
OTHER DRUGS YES NO
INSECTS / FOODS YES NO
Do You Take Any Medications Regularly? YES NO
If Yes, Please List And Explain, (Include Birth Control, Allergy Medication/Shots, Etc.)

Please Fill In As Completely As Possible:

Year of Last Tetanus Shot ____________________ TB Skin Test ________________________________
Sickle Test Index ____________________
When You Participate In Sports, Do You Wear Eyeglasses? __________ And/Or Contacts? __________
(Yes/No) (Yes/No)
If Yes To The Above Question, Please Name The Prescribing Physician Below

(Name) (City) (State) (Phone #)

Describe The Type Of Contacts Worn (Soft, Hard, Gas Permeable, Extended Wear) __________________

Contact Brand __________________ Contact Prescription R _____________ L _________________

Eyeglass Prescription R _____________ L _________________

List All Dental Appliances (Caps, Bridges, Crowns) ____________________________________________

INTERCOLLEGIATE ATHLETICS MORNINGSIDE COLLEGE
PROOF OF INSURANCE ATHLETIC TRAINING
2010-2011

Student Athlete Social Security Number Date of Birth Sport

Dear Parent Parent/Guardian Information

Our athletic accident policy which provides insurance for your son or daughter for injuries occurring while
participating in the play or practice of intercollegiate sports is “SECONDARY” to any other collectible insurance
company providing coverage to your son or daughter through your employer or your spouse’s employer. After your
primary insurance has paid all available benefits, we can file the claim with our athletic insurance company upon your
specific request. Requests for filling must come within 180 days of the initial athletic injury. Keep in mind that our
insurance will not consider a claim until a $500 deductible has been met be either you and/or your insurance. In the
event that our insurance denies the claim for whatever reason the remaining balance is considered your responsibility.
Please note that the school’s general insurance policy for students does not cover athletic injuries.

Primary Policy
Holder’s Name: ___________________________ SS#: _________________ Date of Birth: _________

Home Address: ______________________________________________________________________

Street City, State. Zip Code

Employer’s Name: ___________________________________________________________________

Street City, State, Zip Code

Home Telephone # ___________________________ Work Telephone # ________________________

Insurance Company ___________________________________ Policy # _______________________

IS YOUR DEPENDENT SON/DAUGHTER COVERED UNDER THE ABOVE POLICY? Yes ____ No
____
Does your insurance require: A second opinion for surgery? Yes ____ No ____
Pre-Authorization for service? Yes ____ No ____

Check Appropriate: HMO _____ PPO _____ Co-Pay Required _________

Secondary Policy
Holder’s Name: ___________________________ SS#: _________________ Date of Birth: _________

Home Address: ______________________________________________________________________

Street City, State. Zip Code

Employer’s Name: ___________________________________________________________________

Street City, State, Zip Code

Home Telephone # ___________________________ Work Telephone # ________________________

Insurance Company ___________________________________ Policy # _______________________

IS YOUR DEPENDENT SON/DAUGHTER COVERED UNDER THE ABOVE POLICY? Yes ____ No
____
Does your insurance require: A second opinion for surgery? Yes ____ No ____
Pre-Authorization for service? Yes ____ No ____

Check Appropriate: HMO _____ PPO _____ Co-Pay Required _________

I verify that the above statement of insurance is true, complete and correct to the best of
my knowledge
Signature of Parent/Guardian: Date:
INTERCOLLEGIATE ATHLETICS MORNINGSIDE COLLEGE
PROOF OF INSURANCE ATHLETIC TRAINING
2010-2011

PROOF OFINSURANCE ADDENDUM

PLEASE READ CAREFULLY AND PROVIDE INITIALS AFTER EACH STATEMENT
1. I understand that all student-athletes must maintain primary insurance coverage while participating in
athletics at Morningside College, and that the student-athletes or their primary insurance plan must
cover at least the first $500 of each claim.

Initial _______

2. I understand that if my primary insurance lapses during the course of the school year I will be
responsible for any bills generated after that point. Futhermore, that it is my responsible to maintain a
primary policy in which I have coverage while participating at Morningside College. I will notify the
athletic training staff in the event my coverage has ended or has changed.

Initial ________

3. I understand that coverage denied by my primary policy and Morningside’s Accident Plan will be my
responsibility. Morningside College will assume no responsibility for paying denied claims.

Initial ________

4. I hereby authorize permission to Morningside College, its team physician, and/or athletic trainers to
render first aid, treatment, emergency medical or surgical care deemed necessary for my health and
well being.

Initial ________

5. I hereby authorize Morningside College and EIIA (athletic insurance), and Summit to inspect or secure
copies of case history records, laboratory reports, x-rays, and any other data covering this and/or
previous confinements and/or disabilities. A photocopy of this authorization shall be deemed as
effective and valid as the original.

Initial ________

6. The undersigned hereby acknowledges that he/she understands that many activities of intercollegiate
athletics involves substantial risk of injury. Morningside college’s Athletic Department has provided a
policy which explains to the parent(s)/guardian(s) and the student-athlete that the initial claim must be
filed with the parent’s or student-athlete’s private health insurance company before Morningside
College’s athletic health insurance may be utilized. Thus, the undersigned has, accordingly, been
encouraged to secure adequate insurance protection prior to participation.

Initial ________

7. I have read and agree to the statements of the “Athletic Injury and Referral Policies” (Separate Page).
I will retain the copy provided to me for future reference.

Initial ________

_____________________________ ________ ________________________________ _______

Student-Athlete Signature Date Parent/Guardian Signature Date

_____________________________ ________
Student-Athlete’s Spouse Signature Date
INTERCOLLEGIATE ATHLETICS MORNINGSIDE COLLEGE
PROOF OF INSURANCE ATHLETIC TRAINING
2010-2011

Student Athlete Social Security Number Date of Birth Sport

Acknowledgment of Athletic Injury and Medical Referral Policies

I, ____________________, have read and agree to comply with the Athletic Injury and Medical Referral
policies as put forth by the Morningside College Athletic Department. My signature below verifies that I
have read, understand and have been provided with a copy of these policies.

______________________ _________
(Student – Athlete) Date

______________________ _________
(Parent/Guardian/Spouse) Date

INFORMED CONSENT FOR RELEASE OF MEDICAL INFORMATION

I, ____________________, give the certified athletic trainers employed by Morningside College and
CNOS Sports Medicine, permission to share medical and insurance information with the Team Physicians
and or other medical professionals regarding injuries, illness, or other medical /psychological /personal
conditions that may affect my participation in any way with Morningside College Intercollegiate Athletics
sanctioned practices, contests, team functions, and events.

I understand that this information will be shared for referrals and correspondence with physicians and
medical professionals who are directly involved with my care.

Furthermore, I understand that in order for the Educational and Institutional Insurance Administrations,
Inc./Summit (Morningside College’s excess Athletic Accident Plan administrator) to process claims they
must be provided with injury reports, dictations, and follow up notes which are provided through the
certified athletic trainers.

Signature of student-athlete _______________________ Date ________________

PLEASE ATTACH COPIES OF YOUR INSURANCE CARD BELOW

FRONT BACK
INTERCOLLEGIATE ATHLETICS MORNINGSIDE COLLEGE
HEALTH HISTORY ATHLETIC TRAINING
2010-2011

Student Athlete Social Security Number Date of Birth Sport

1. Do you have asthma? Yes

No
2. Do you cough, wheeze, or have trouble breathing during or after activity? Yes
No
3. Have you ever had racing of your heart or skipped heartbeats? Yes No
4. Have you ever had high blood pressure or high cholesterol? Yes No
5. Have you ever been told you have a heart murmur? Yes No
6. Do you have a family member with a history of Marfans Syndrome? Yes No
7. Has any family member or relative died of heart problems or of sudden Yes No
death before age 50?
8. Have you ever had any chest pain during or after exercise? Yes No
9. Has a physician ever denied or restricted your participation in sports for any Yes No
heart problems?
10. Have you ever had a head injury or concussion? Yes
No
11. Have you ever been knocked out, become unconscious, or lost your memory? Yes No
12. Have you ever had a stinger/burner in your neck, shoulder, arm, or hand due to Yes No
participation in athletics?
13. Have you ever passed out during or after exercise? Yes No
14. Have you ever used steroids or other performance enhancing agents Yes No
15. Do you get tired more quickly than your peers do during exercise? Yes
No
16. Have you ever become ill from exercising in the heat? Yes
No
17. Other than heat related, have you ever been dizzy during or after exercise? Yes
No
18. Do you have seasonal allergies? Yes No
19. Do you have a history of diabetes? Yes No
20. Are you missing an eye, kidney, ovary, or testicle? Yes No
21. Have you had a severe viral infection (for example, myocarditis, mononucleosis)Yes No
within the last month?
22. Do you want to weight more or less than you do now? (Circle One) List Goal Weight _______ lb.
23. Do you lose or gain weight regularly to meet weight requirements for your sport? Yes
No
24. Have you ever been diagnosed with an eating disorder of any type? Yes
No
25. Have you ever had a broken or fractured bone, sprain, or severely strained Yes
No
or pulled a muscle?
26. Have you ever participated in athletics against the advice of a medial professional? Yes
No
Males Only
27. Have you ever had a hernia? Yes
No
28. Do you have two functioning testicles? Yes
No
Females Only
29. When was your first menstrual period?
___________________________________________________
30. When was your most recent menstrual period?
_____________________________________________
31. How much time do you usually have from the start of one period to the start of another?
____________
32. How many periods have you had in the last year?
__________________________________________
 33. What was the longest time between periods?
______________________________________________

Please elaborate on any questions to which you answered yes,

______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

Student Athlete Signature ______________________Parent/Guardian Signature_____________________

INTERCOLLEGIATE ATHLETICS MORNINGSIDE COLLEGE
PRE-EXISTING CONDITIONS ATHLETIC TRAINING
2010-2011

Student Athlete Social Security Number Date of Birth Sport

It is the policy of Morningside College, its Athletic Department, and Morningside

College Athletic Training that we (stated above) will not assume responsibility, financial
or otherwise, for injury, illness, or medical conditions occurring and/or existing prior to
the first official day of participation in intercollegiate athletics at Morningside College.

It is required that the student-athlete have proper documentation from their previous
physician(s) or health care providers about significant injuries or conditions prior to
arrival at Morningside College, so that proper evaluation can occur prior to beginning
participation as well as appropriate follow-up care if the condition or injury is aggravated
or re-injured.

It is noted that the National Association of Intercollegiate Athletics (NAIA) prohibits the
college from being financially or otherwise responsible for any injury, illness, or
condition incurred while not engaging in intercollegiate athletic activity.

I, _________________ (student-athlete name) understand that I can be restricted or

eliminated from participation in intercollegiate athletics due to a pre-existing condition if
deemed appropriate by a Morningside College team physician, athletic training staff
member, or other qualified medical personal acting in the best interest of myself and/or
Morningside College.

By signing, I agree that I have read this policy and agree to the terms described within it.

_____________________ _______ _____________________ ________

Student-Athlete Signature Date Parent/Guardian/Spouse Date
INTERCOLLEGIATE ATHLETICS MORNINGSIDE COLLEGE
ASSUMPTION OF RISK ATHLETIC TRAINING
2010-2011

Student Athlete Social Security Number Date of Birth Sport

The student-athlete and a parent/guardian, if the student is a minor at the time of signing, must read
carefully, initial and sign.

I, _________________, (student athletes name) am aware that playing or participating to play/participate in

any sport can be a dangerous activity involving many risks of injury. I understand that the dangers and
risks of playing or participating to play/participate in the above sport include, but are not limited to death,
serious neck and spinal injuries which may result in complete or partial paralysis, brain damage, serious
injury to virtually all internal organs, serious injury involving bones, joints, ligaments, muscles, tendons,
and other aspects of my body, general health and well-being. I understand that the dangers and risks of
playing may result not only in serious injury, but in a serious impairment of my future abilities to earn a
living, to engage in other business, social, and recreational activities, and generally to enjoy life.

Because of the dangers of participating in the above -mentioned sport(s), I recognize the importance of
following coach’s instructions concerning playing technique, training and other team rules, etc., and to
agree to obey such instructions. Furthermore, to follow the advise/instructions of the team physicians and
athletic training staff.

I also recognize that the risk of the above mentioned injuries/conditions is present even when following
coach’s instructions concerning playing technique, training, and other team rules, etc.

I further authorize the Athletic Training staff at the above mentioned institution who are under the direction
and guidance of Morningside College’s team physicians, to render any preventive technique, accepted
method of injury care, rehabilitative techniques/reconditioning, health education counseling, or emergency
treatment deemed reasonably necessary to protect, maintain or promote the health well-being of the student
athlete listed above.

________ Student-Athlete Initials ________ Parent/Guardian/Spouse Initials

I, ______________________, (student-athletes name) agree to share in confidence the perimeters of my

signs and symptoms of injury/illness with the team physician, athletic training staff, and other members of
the sports medicine network. Furthermore, I take personal responsibility to meet appointments, report
changes on condition and take an active part in potential rehabilitative measures for my well-being.

I also authorize the athletic training staff and/or other medical consultants to evaluate and treat my injuries
that occur during my participation in intercollegiate athletics at Morningside College. I understand the
team physicians, athletic training staff and other qualified medical personnel have the authority to eliminate
me from further participation because of an injury, illness, medical condition, and/or because of an undue
liability risk to Morningside College.

________ Student Athlete Initials _________ Parent/Guardian/Spouse Initials

The signature of the student athlete, parent/guardian/spouse (if appropriate) are required below to signify
acceptance by the said student-athlete, parent/guardian/spouse that they have read and hereby understand
the term and conditions of the Morningside College Athletic Injury and Medical Policy and will hereby
return all information as requested previously.

____________________________ ________ __________________________ ________

Student-Athlete Signature Date Parent/Guardian/Spouse Date
INTERCOLLEGIATE ATHLETICS MORNINGSIDE COLLEGE
RELEASE & WAIVER ATHLETIC TRAINING
2010-2011

Student Athlete Social Security Number Date of Birth Sport

In recognition of and with knowledge of the fact that engaging in the sport of _________
involves a substantial risk of personal injury. I the undersigned and appropriate parent or
guardian, warrant that I am presently in good physical condition and hereby agree to
assume the risk of any injury or condition that I may suffer as a result of my participation
in ____________________ at Morningside College from ____________(beginning date)
until ____________ (end date).

Therefore, in consideration for being permitted to participate in such activity, I hereby

release, waive, and forever discharge Morningside College, its agents, employees,
affiliates, contracted employees, associates and officers from any and every claim,
demand, or action of whatever kind, arising from any bodily harm, personal injury or
death resulting from any accident which may occur as a result of participation in the
above mentioned activity. Further, and to the same extend and scope, I release said
parties from any claim whatsoever which may be attributable to the receipt of first aid,
medical care or other emergency treatment rendered me in connection with my
participation in such activity.

I, the undersigned, affirmatively swear that I am at the time of this signing of legal age
(or if not of legal age will have an appropriate parent or guardian sign as well) and fully
competent to and do hereby execute this Release and Waiver on behalf of myself, my
heirs, or assigns. I furthermore represent and warrant that I have read and fully
understand the terms of this document and their legal significance.

In witness whereof I have voluntarily and without inducement from any party executed
this Release and Waiver on ______________ (date).

_________________________ __________
Student-Athlete Signature Date

_________________________ __________
Parent/Guardian Signature Date
SUBSTANCE ABUSE TESTING MORNINGSIDE COLLEGE
VOLUNTARY SUBMISSION ATHLETIC TRAINING
2010-2011

Student Athlete Social Security Number Date of Birth Sport

The acceptance of membership on any athletic team bearing Morningside College name,
logo, or mascot constitutes an agreement to comply with all the regulations of
Morningside College, its athletic department, and its affiliated organizations and
programs. A voluntary consent to undergo and cooperate in drug testing is encouraged.
Drug testing may occur should just-cause or evidence beyond a reasonable doubt be
presented or apparent to any member of the Morningside College coaching staff, Athletic
Training staff, departmental administrative staff or other appropriate Morningside
College faculty or staff. Testing may also occur on a random basis terminated by the
Director of Athletics.

I,_________________, fully understand that I may be temporarily or permanently

suspended from a team or there may be a recommendation made for non-renewal of my
scholarship, if applicable, for violation of substance abuse policy illegal by law,
competitive rules or Morningside College policy. I also understand that TERMINATION
of team membership and recommended non-renewal of any athletic scholarship MAY
occur at the time of a POSITIVE TEST, after appropriate appeals process if I so choose.

I understand and agree with the above-mentioned penalty for a positive drug test and
violation of substance abuse policy. I agree to fully accept and comply with the decision
and consequences determined appropriate by the Director of Athletics and/or Associate
Director of Athletics that any expenses incurred for counseling, rehabilitation, substance
abuse education or other such services are my sole responsibility.

_______ Initial

The drugs TO BE TESTED for include, but are not limited to the following:
ALCOHOL, AMPHETAMINES, COCAINE, MARIJUANA, PCP, OPIATES,
PHENCYCLIDINE, METHAQUALONE, BARBITUATES, BENZOPAIN,
METHADONE, and ANABOLIC STEROIDS.

I understand, agree to comply with and participate in Morningside College Athletic

Department voluntary substance abuse testing within the above stated guidelines. I also
understand that any and all information INCLUDING drug test results pertaining to such
incidents may be reviewed by Morningside College Administration for review and
possible action independent of the Athletic Department.

SIGNED: ___________________________________________ DATE: ___________

PARENT (if needed): _________________________________ DATE: ___________

Dear Morningside College Parents/Guardians and Student-Athletes,

It is the responsibility of the Athletic Training Staff to coordinate the care provided prior to, during, and
after an athletic related injury or illness for those student-athletes who participate in intercollegiate athletics
at Morningside College. Our staff’s activities include prevention, recognition, and evaluation, managed
care and referral, rehabilitation and reconditioning, education and counseling regarding athletic injuries and
illnesses. We are pleased to serve Morningside College and its student-athletes.

Dr. Merle Muller serves as our Head Team Physician and oversees all care provided to our student-athletes.
In addition to his duties at the Family Practice Center, he serves as a coordinator for the Siouxland Medical
Residency Program in teaching new physicians how to be successful.

Dr. Meis serves as our orthopaedic consultants. Dr Meis is sports medicine trained orthopaedic physicians
and have extensive training and experience dealing with athletic injuries. Their practice, The Center for
Neurosciences, Orthopaedics, & Spine (CNOS) is located at 575 Sioux Point Road in Dakota Dunes, South
Dakota.

If you do not currently have a primary insurance policy that will cover your son or daughter in this
provider area, I urge you to begin the process quickly. Contact an agent you are comfortable with and
share this letter with them so that you will be prepared for the upcoming school year. If you are
considering Short Term Major Medical plan, be sure to verify that it will cover athletic injuries, as some of
them do not. No student-athlete will be allowed to participate in organized practice or competition until the
Proof of Insurance forms, as well as all Athletic Department forms are completed and on file in the Athletic
Training Room with the Athletic Department. Furthermore, the insurance policy that is maintained by the
athletic department is a secondary policy, thus, it will not pay until the primary carrier has processed the
claim/bills, and met at least the deductible ($500 minimum per claim) as described in the athletic
department policy. Also keep in mind that neither Morningside College nor E.I.I.A/Summit (our athletic
insurance carrier) will pay for injuries that are not directly related to intercollegiate athletic participation.
Illness is not covered at all under the athletic department’s secondary insurance policy, as it is not directly
related to athletic accidents that may occur. Taking that into account, your primary should give you peace
of mind that your son or daughter has coverage regardless of what may happen to him or her in- or outside
of athletics.

Please keep in mind, the policy that is offered to all Morningside students during registration (John Rice
Agency), is an attractive value…but will not cover athletic injuries, and therefore will not meet the athletic
department’s requirement for Proof of Insurance. Also please note that if there is a remaining balance after
both your and Morningside’s insurance process the claim, Morningside College is not responsible for the
remaining balance. I encourage you and your son/daughter to become familiar with the mechanics of your
coverage. Examples: limited # of physicians, notification of company, permission for treatment, high
deductibles, etc. If we all are familiar with our policies, often many headaches can be avoided.

Please fill out All of the forms completely and return them to us as soon as possible prior to your
son/daughter’s arrival on campus. Athletes will not be allowed to participate in practice or
competition until all forms are complete and they have been cleared on their on-campus physical!

We look forward to the upcoming academic year and the promise it brings. If you have questions please do
not hesitate to call on us.

Go Mustangs!!!
Greg Seier, MSE ATC/L
Athletic Trainer
712-274-5314
 Athletic Department
ATHLETIC INJURY AND REFERRAL POLICIES

THESE POLICIES ARE DESIGNED FOR THE PROTECTION OF THE STUDENT-ATHLETE

PARTICIPATING IN THE MORNINGSIDE COLLEGE INTERCOLLIEGIATE ATHLETIC
PROGRAM, AND FOR THE DEPARTMENT OF ATHLETICS AT MORNINGSIDE COLLEGE.

1. The packet with your medical history, proof of insurance, waivers, and other forms as well as an
on campus athletic physical conducted by a Morningside College team physician must be
completed, signed, and dated and on file prior to clearance for participation in any Morningside
College sanctioned intercollegiate athletic practice or contest. (You will not be allowed to
participate in intercollegiate athletics without evidence of primary insurance.) You must also
provide Morningside College with a photocopy of your insurance card (front & back) as stated on
the Proof of Insurance form as well as any other appropriate medical documentation about
pertinent, prior and/or current medical conditions.
2. All student-athletes must maintain primary insurance coverage throughout the entire school year.
This means they must be covered by a plan/policy that will pay claims should they become injured
or ill during a practice or contest.
3. Should the student-athlete lose or change coverage for any reason (parent changes job, employer
changes insurance, etc.) the student-athlete is responsible for notifying the athletic training staff as
soon as possible. The student-athletes are furthermore responsible for restoring coverage for
themselves in some manner. Morningside College does not assume responsibility of medical bills
for any athletic related injury for any student-athlete. A claim may be made to the secondary
insurance carrier upon request within the 180-day claim period set by the company.
4. If injured during a contest or practice, inform the ATC (certified athletic trainer) assigned to your
team for proper follow-up. If signs and symptoms appear away from the athletic setting, report to
the Athletic Training Room, ASAP, for care and follow-up.
5. Report all new injuries or illnesses to the supervising ATC prior to 10:00 am the following day for
proper care and notification of the coaching staff. NOTE: Illnesses are not covered by the Athletic
Accident Plan carried by Morningside College. This is an additional reason to maintain primary
insurance coverage. However, the ATC’s will assist with the proper referral in all cases.
6. If medical care is needed during a time when the Athletic Training Room is closed, try to contact a
member of the athletic training staff, or if urgent, report to Mercy Medical Center (6th & Douglas)
or St. Luke’s Regional Medical Center (28th & Pierce). Make sure to notify your primary
insurance carrier and the Athletic Training staff AS SOON AS POSSIBLE.
7. Morningside College has a special arrangement for accelerated appointment scheduling with
quality physicians and medical professionals to care for the needs of our student-athletes. In the
interest of the college, we ask that our team physician handle medical referrals and care if
possible.
8. If you seek medical treatment without a referral from a staff ATC, you will be responsible for all
bills/expenses incurred. You will also be required to obtain the appropriate documents (i.e.
dictations, rehab prescription) explaining the care and treatment given to you outside of the
Morningside College Sports Medicine Network. Prior to your return to activity after a significant
injury or surgery, you will need a medical release from a Morningside College Team Physician
Prior to returning to activity regardless of other release obtained.
9. In the event that you are injured and require surgery or other testing, our Team Physician will see
you first and conduct the initial evaluation. If you are insured by a PPO or an HMO network,
contact them and obtain authorization for treatment immediately. If you are not insured by a
PPO/HMO network and elect to have surgery without a referral from the Morningside Athletic
Department, you will be responsible for the bills. You are encouraged to contact your insurance
carrier prior to filling out the paperwork requested by the Athletic Training Staff, so that the policy
holder, the insured (student-athlete) and the athletic training staff all understand what is required
in the event of an injury.
10. The staff ATC’s will be responsible for making all initial referrals and appointments. You will
ultimately be responsible for keeping such appointments and making transportation arrangements.
In some cases a fee for missed appointments may be assessed. Again, you are encouraged to
contact your insurance carrier prior to filling out the paperwork requested by the Athletic Training
Staff, so that the policy holder, the insured (student-athlete) and the athletic training staff all
understand what is required in the event of an injury.
11. Medical bills generated by an athletic injury must be submitted to your primary insurance first.
The Morningside College Athletic Accident Plan provides coverage in excess of the student-
athlete’s/parent’s coverage. Copies of your insurance carrier’s pay or denial statements
(“explanation of benefits”) are required before any medical charge is considered by the
Morningside College Athletic Accident Plan. When at least the first $500 is paid by your
insurance or you, the Athletic Training Staff can submit a claim form (completed by the student-
athlete) for consideration of excess payable charges. This is done on request only and the claim
must be over the $500 deductible.
12. The documents provided to Morningside College Athletic training regarding medical history and
physicals should be completed with accuracy. If these are deemed inaccurate, the student-athlete
may be required to pay for medical care to correct preexisting conditions or other ailments in
question and jeopardize their athletic eligibility.
13. No athlete will be recommended for medical hardship unless the above procedures have been
followed and a Morningside College Team Physician has been consulted. The team physician and
our athletic conference officials shall be the final authority for medical hardship and related
situations.
14. The student-athletes are encouraged to share, in complete confidentiality, any other non-athletic
medical issues, conditions or concerns that they may have with the Certified Athletic Trainers.
These issues could include: pregnancy, conditions (physical or psychological), and disorders
(physical or psychological). The athletic training staff has been specially trained to assist in these
matters and has specialists at various facilities waiting to assist in any way they can.
15. The athletic director, athletic training staff, and team physicians will have the final say regarding
the interpretation of the above-mentioned policies.
 Morningside College Sports Medicine Providers
Certified Athletic Trainers
Greg Seier, MSE ATC/L
Head Athletic Trainer
1501 Morningside Avenue
Sioux City IA 51106
Office: (712) 274-5314
Fax: (712) 274-5578
seier@morningside.edu

Head Team Physician

Dr. Merle Muller
Family Practice Center
2501 Pierce Street
Sioux City, IA 51106
Office: (712)-294-5000

Team Orthopaedic Physicians

Dr. Ryan Meis
CNOS Sports Medicine
575 Sioux Point Road
Dakota Dunes, SD 57049
Office: (605)-217-2667

Please feel free to contact Greg at any time with any questions about the care of your son
or daughter. Our goal is provide the best possible health care for the student athletes,
please allow us to coordinate all appointments and referrals when possible.

Thank You,
Morningside College Athletic Training Staff
Physical Forms Checklist

□ Personal Data
□ Proof of Insurance – 3 Sheets
□ Copy of Insurance Card
□ Health History or Health Status Review**
□ Assumption of Risk
□ Pre-existing Conditions
□ Release & Waiver
□ Substance Abuse Testing Waiver

**If you have an ongoing medical condition (heart

murmur, diabetes, cancer, etc.), please include all
available documentation and clearance from your
physician.

Please make sure that all of the forms are completed entirely, signed, and
dated.

Thank you for your assistance in getting your paperwork completed and
returned by July 16th 2010

Sincerely,
Athletic Training Staff

Morningside College
Athletic Training
1501 Morningside Avenue
Sioux City, IA 51106