Nfhs Medical Release Form For Wrestler To Participate With Skin Lesion(S) (Page 2 of 2) in pdf

NFHS/MHSAA COMMUNICABLE DISEASE

- PHYSICIAN EVALUATION -

Name: _____________________________________________________

Date of Exam: ___ / ____ / ___

Diagnosis ___________________________________________________

Mark Location AND Number of Lesion(s)

___________________________________________________________

Location AND Number of Lesion(s) _________________________

____________________________________________________

Medication(s) Used to Treat Lesion(s): _______________________

____________________________________________________

Date Treatment Started: ___ / ____ / ____

Time: _____________

Earliest Date the Wrestler May Return to Participation: ____ / ____ / ____

Provider Signature ___________________________________ Office Phone #: _____________

Provider Name (Must Be Legible) __________________________________________________

(MD, DO, PA or NP)

Office Address _______________________________________________________________

Below are some treatment guidelines that suggest MINIMUM TREATMENT before return to wrestling:

Bacterial Diseases (impetigo, boils): To be considered “non-contagious,” all lesions must be scabbed over with no oozing or discharge and no new lesions should

have occurred in the preceding 48 hours. Oral antibiotic for three days is considered a minimum to achieve that status. If new lesions continue to develop or drain

after 72 hours, MRSA (Methicillin Resistant Staphylococcus Aureus) should be considered.

Herpetic Lesions (Simplex, fever blisters/cold sores, Zoster, Gladiatorum): To be considered “non-contagious,” all lesions must be scabbed over with no oozing or

discharge and no new lesions should have occurred in the preceding 48 hours. For primary (first episode of Herpes Gladiatorum), wrestlers should be treated and

not allowed to compete for a minimum of 10 days. If general body signs and symptoms like fever and swollen lymph nodes are present, that minimum period of

treatment should be extended to 14 days. Recurrent outbreaks require a minimum of 120 hours of oral anti-viral treatment, again so long as no new lesions have

developed and all lesions are scabbed over.

Tinea Lesions (ringworm on scalp or skin): Oral or topical treatment for 72 hours on skin and oral treatment for 14 days on scalp.

Scabies, Head Lice: 24 hours after appropriate topical management.

Conjunctivitis (Pink Eye): 24 hours of topical or oral medication and no discharge.

Molluscum Contagiosum: Upon treatment with curettage and hyfrecator, may cover with biooclusive and wrestle immediately.

Note to Appropriate Health-Care Professionals: Non-contagious lesions do not require treatment prior to return to participation (e.g. eczema, psoriasis, etc.). Please

familiarize yourself with NFHS Wrestling Rules 4-2-3, 4-2-4 and 4-2-5 which states:

“ART. 3 . . . If a participant is suspected by the referee or coach of having a communicable skin disease or any other condition that makes participation appear

inadvisable, the coach shall provide current written documentation as defined by the NFHS or the state associations, from an appropriate health-care professional

stating that the suspected disease or condition is not communicable and that the athlete’s participation would not be harmful to any opponent. This document

shall be furnished at the weigh-in for the dual meet or tournament. The only exception would be if a designated, on-site meet appropriate health-care professional

is present and is able to examine the wrestler either immediately prior to or immediately after the weigh-in. Covering a communicable condition shall not be

considered acceptable and does not make the wrestler eligible to participate.”

“ART. 4 . . . If a designated on-site meet appropriate health-care professional is present, he/she may overrule the diagnosis of the appropriate health-care

professional signing the medical release form for a wrestler to participate or not participate with a particular skin condition.”

“ART. 5 . . . A contestant may have documentation from an appropriate health-care professional only indicating a specific condition such as a birthmark or other

non-communicable skin conditions such as psoriasis and eczema, and that documentation is valid for the duration of the season. It is valid with the understanding

that a chronic condition could become secondarily infected and may require re-evaluation.”

Once a lesion is considered non-contagious, it may be covered to allow participation.

DISCLAIMER: The National Federation of State High School Associations (NFHS) shall not be liable or responsible, in any way, for any diagnosis or other evaluation made herein, or exam

performed in connection therewith, by the above named provider, or for any subsequent action taken, in whole or part, in reliance upon the accuracy or veracity of the information provided herein.

Revised/Approved by NFHS SMAC - April 2015

Nfhs Medical Release Form For Wrestler To Participate With Skin Lesion(S) Page 2

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