Medical Diagnostic Form For Athletes Who Are Participating In Ibsf Para-Sport Events (Page 4 of 4) in pdf

Medical Diagnostic Form For Athletes Who Are Participating In Ibsf Para-Sport Events Page 4

Additional required documentation as it relates to specific impairments is as follows:

 Multiple Sclerosis – brain and spine MRI and lab results confirming MS

diagnosis, documentation must be less than six (6) months old;

 Spinal cord injury – Medical report that states the date of injury, mechanism of

injury, ASIA score, extent of fixation (if applicable) and any subsequent

relevant surgeries that have impacted eligibility criteria;

 Dysmelia in lower extremities – radiograph of limb(s) affected;

 Amputation – report from surgical procedure or documentation noting

congenital deformity, radiograph of the residual limb(s);



Neurological impairments (cerebral palsy, spina bifida or similar) –

documentation from medical specialist including discussion of condition,

surgeries, all medications used and recent or planned treatments.

Athletes and NPCs/ NFs are advised to observe the Eligible Imairments defined in each

Sport’s classification rules, as not all of the impairments mentioned above are considered

Eligible Impairments in all sports.

☐ I confirm that the above information is accurate.

Name: ______________________

Health care profession: ______________________

Registration Authority and Number: ______________________

Address: ____________________________________________

City: ______________________

Country: ______________________

Phone: ______________________

E-mail: ______________________

Date: ______________________

Signature: ______________________

☐ I certify that the above-mentioned information is correct. My data will be used to

obtain the information for IBSF and will not be disclosed to third person.

Date: ______________________

Signature of Athlete ______________________

Medical Diagnostic Form For Athletes Who Are Participating In Ibsf Para-Sport Events Page 4