Medical Diagnostic Form For Athletes Who Are Participating In Ibsf Para-Sport Events

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Medical Diagnostic Form for athletes who are participating in IBSF
Para-sport events.
 This form needs to be completed in English by the athlete and athlete’s individual physician.
 The completed form must be sent to national level classifier for verification at least six weeks
before the athlete undergoes athlete evaluation.
The athlete’s health condition as stated on this form and the resulting impairment must fully explain the loss of
function exhibited by the athlete during athlete evaluation. Otherwise no sport class can be allocated by
the Classification Panel.
 Reports on additional testing by physicians, physiotherapists and other health professionals are welcomed, where
relevant, to complement the medical diagnostic information.
 The International Bobsleigh & Skeleton Federation and Classification Panel can ask for further information to be
submitted depending on the individual athlete’s health condition and impairment.
Full name: ___________________________________________________________
Country: _______________________
Address: ___________________________________________________________
Date of birth :(dd.mm.yyyy.)____________________ Female ☐ Male ☐
Height: ___________
Weight: ___________
Phone number: ________________________
Email: _________________________________
Date: _______________
Please check the type of physical disability that the athlete has:
☐ complete spinal cord injury: list spinal level of injury: ___________
☐ incomplete spinal cord injury: list spinal level of injury: __________
☐ lower limb deficiency: list side(s) and level of limb deficiency: ___________
☐ upper limb deficiency: list side(s) and level of limb deficiency: ____________
☐ cerebral palsy
☐ Other: _________________________
Description of the Athlete’s medical diagnosis and the loss of function this health condition results in:
Health condition is: ☐ progressive ☐ stable ☐ fluctuating
Health condition is: ☐ acquired ☐ congenital
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