Medical Diagnostics Form For Athletes With Physical Impairment
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3Medical Diagnostics Form
for athletes with physical impairment
The form must be completed in English by a registered medical doctor (M.D.) with a
specialization of the Athlete’s Health Condition.
The completed form with attached medical documentation must be uploaded to the athlete’s
SDMS profile upon registration of the athlete to the SDMS. This applies for all athletes with
physical impairment competing in Para Athletics. Depending on the athlete’s health condition
and impairment, additional medical information is to be attached to this form (see page 2).
Note
The measurement of impairment seen during athlete evaluation must correspond to the
diagnosis indicated below. If the medical documentation is incomplete, Para Athletics holds the
right to request further information. In absence of such information, the athlete will not be able
to proceed with Athlete Evaluation.
Athlete Information
(to be prepopulated by the NPC)
Family name:
Given name:
Gender:
Female
Male
Date of Birth:
(dd/mm/yyyy)
NPC:
SDMS ID:
The athlete’s Sport Class Status is New
The athlete’s Sport Class Status is Review
International Paralympic Committee
Adenauerallee 212-214
Tel. +49 228 2097-200
53113 Bonn, Germany
Fax +49 228 2097-209
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Parent category: Medical