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GILBERT HIGH SCHOOLPRE-PARTICIPATION PACKET FOR ATHLETICSEducational Information found at gilbertathletics.org under Sports Medicine tabFull Pre-Participation Packets are available at GHSThe GHS Pre-participation Packet for Athletics contains important information regarding health & safetythat should be reviewed by athletes and their parents prior to athletic participation at GHS or GMS.Checklist1. Online @ gilbertathletics.org for your review: Parent letter regarding sports medicine services Information regarding GHS athletic training staff and team physicians Educational information regarding concussion, sickle cell trait, common skin infections, suddencardiac death, heat illness, proper tackling technique, blood hygiene, nutrition, dietarysupplements, and energy drinks Instructions for creating an account, completing required digital pre-participation forms, anduploading the completed SCHSL Physical Exam Form on PlanetHS.com2. Print SCHSL Physical form. Take form with you to exam to be cleared by healthcare provider.3. PlanetHS – New athletes and parents should create a PlanetHS account. Returning athletes andparents should log into an existing PlanetHS account. All athletes and parents should be completerequired digital pre-participation forms. Forms to be completed digitally on PlanetHS.com (you can choose to REUSE previous yearsforms- see form “Returning (student/parent) Athletic Pre-Participation Forms Registration”)o Pre-participation Physical Exam History Form (Print for to take with you when you goto have physical examination completed by Healthcare professional)o Parent’s Permission & Acknowledgement of Risk for Son/Daughter to Participate inAthleticso Concussion Acknowledgement and Signature Formo Consent and Medical Information Form Forms to be uploaded to Planeths.com(upload a picture or scanned document)o Pre-participation Physical Examination form (back page of physical that should becompleted by healthcare professional)o Birth Certificate GMS Students please select GHS as “OTHER” school
Dear Parent:As Gilbert High School’s head athletic trainer, I am responsible for coordination sports medicine/athletic trainingservices for GHS athletes. Our sports medicine program’s focus is to prevent, evaluate, treat, and rehabilitate injuriesincurred by GHS athletes during the course of practice and competition. Attached are a few reminders that help usserve your athlete both effectively and efficiently.PRE-PARTICIPATION PAPERWORK: All athletes are required to submit a completed SCHSL pre-participation physicalexam form (health history, parent permission, and physician exam) and a GHS Sports Health form before being allowedto participation in athletics, including try-outs and strength/conditioning sessions. Parents are encouraged to make acopy of all documents for their files before submitting to the school. SCHSL requires a physical to be conducted afterApril 1st, 2019 for athletic participation in 2019-2020.ATHLETIC INJURIES: In the event your student-athlete becomes injured during the season, he/she should report to theathletic training room (525). The athletic training room is open for injury evaluations and treatments after school at3:25 pm. In most cases our AT staff can handle the injury without a referral to a physician or emergency room. TheIndian sports medicine program also offers rehab services for sports injuries sustained during participation with atGHS/SCHSL – sanctioned team.Physician Referrals: When a physician referral is needed, we can assist with the arrangement of the appointment.Palmetto Health USC Orthopedics serves as the team physicians for our athletics program. Typically we can arrange anappointment within 24 hours. If you prefer to see another physician, we may be able to assist with that appointment aswell. Anytime a physician examines an athlete, he/she should return with written documentation from the doctorincluding the diagnosis, recommendations, and restrictions for athletic participation. Please return this document tothe head athletic trainer upon returning to school.ATHLETIC ACCIDENT INSURACNE: While an athlete’s parent is ultimately responsible for medical bills incurredbecause of injury/illness during athletic participation, Lexington 1 does provide secondary athletic accident insurancefor athletes who are injured while participating in official team functions. The policy is intended to be an “excess” policydesigned to pay secondarily to the athlete’s primary health insurance. Parents of an injured athlete, who has beenreferred to a physician by a staff athletic trainer, should receive a claim form. The parent should complete the claimform and follow the directions to file the claim. Parents are strongly encouraged to make a photocopy of the completedclaim form for their records. In the event an athlete sees a physician for an injury, but was not referred by a staffathletic trainer, the athlete’s parents should contact the head athletic trainer ASAP. Failure to do so may result in a claimnot being filed. All claims must be filed within 90 days of injury.INJURIES DURING A GAME: In the unfortunate event that your athlete is injured during a game, please remain in yourseat in the stands. I understand that this may be difficult, but a frantic parent rushing the field only stirs emotions in theinjured athlete, which can make assessment and care of the injury more difficult. After the injury is evaluated and initialtreatment is provided, the parent will be called to the sideline/athletic training room to be informed of the nature of theinjury along with recommendations for care.Indian Sports Medicine is committed to providing GHS athletes with the best athletic healthcare possible. Please call ifyou have any questions or concernsByron Millwood, MS, ATC/SCATHead Athletic Trainer, Gilbert High SchoolPhone: 803-821-1985 Fax: 803-821-1938 Email: bmillwood@lexington1.netFor more information about our Sports Medicine Program please visit http://gilbertathletics.org
Gilbert High School Athletic Training StaffByron Millwood - Head Athletic TrainerByron Millwood has served as Gilbert High Schools head athletic trainer since 2006. Underdirection of the physicians at the Moore Center for Orthopaedics, Mr. Millwood isresponsible for coordinating sports medicine services for GHS athletes and teachingsports medicine classes. Byron holds national and state certification as an athletic trainer.He earned his undergraduate and Masters degree from the University of South Carolina.Before coming to Gilbert High Byron was a staff athletic trainer at Hammond School inColumbia, and worked with football, baseball, track, swimming and diving, and women’ssoccer as a student at the University of South Carolina. Byron is a member of the NationalAthletic Trainers’ Association, the South Carolina Athletic Trainers’ Association, and the South Carolina AthleticCoaches Association. Byron has served on the Lexington 1 health advisory council, South Carolina book adoptioncommittee for Sports Medicine, and the Sports Medicine Standards committee. In 2013 Byron was selected as theathletic trainer for the South team during the North/South Football game. Originally from Gaffney, South Carolina,Byron and his wife Erica live in Lexington and have a son, Sawyer and daughter, Sadie.803-821-1985bmillwood@lexington1.netEmily Whittington – Athletic TrainerMs. Emily Whittington has served as an athletic trainer at Gilbert High School since2013. In addition to her duties in athletics, she also serves as an instructor for HealthScience and Sports Medicine courses. She is nationally certified as an athletic trainer bythe Board of Certification for Athletic Training, as well as the State of South Carolina. Emilyreceived her athletic training degree from Western Carolina University and M.S. from theUniversity of South Carolina. During her time as an undergraduate at Western, sheworked with the soccer, basketball, softball, as well as at local high schools around thecommunity. While a graduate assistant athletic trainer at USC, she served as the athletictrainer for the Equestrian team as well as the assistant athletic trainer at Heathwood Hall Episcopal School. Ms.Whittington also interned at the University of Virginia with their football team. Ms. Whittington is a member of theNational Athletic Trainers’ Association, the South Carolina Athletic Trainers’ Association, and serves as an advisor forGilbert’s Chapter of the Health Occupations Students of America. Originally from Marion, North Carolina, Ms.Whittington lives in J Marsh – Athletic TrainerMrs. TJ Marsh is a Staff Athletic Trainer for Palmetto Health USC Orthopedics and hasbeen a member of the Gilbert Sports Medicine staff since 2010. Originally from Georgia,she received her Bachelor’s degree from the University of Georgia in 1995, a Master ofEducation from Northwestern State University in Natchitoches, Louisiana in 1998, and herNational Registry of Emergency Medical Technicians- Paramedic Certificate fromTennessee Tech University in 2003. TJ is state and nationally certified as an athletictrainer, as well as an American Heart Association certified instructor of Advanced CardiacLife Support, CPR, and First Aid. She is also state and nationally certified as a paramedic.Her career has included experience with ice hockey at the semi-professional level, as well as combining her athletictraining and paramedic skills in event medical planning, for events such as NFL-Tennessee Titans and the UnitedStates Marine Corps Mud Run here in Columbia 2010-11. However her first love and the majority of her 18 years asan athletic trainer has been spent in small town, rural high school athletics across Louisiana, Tennessee, Kentuckyand here in the Midlands of South Carolina. She moved to South Carolina in 2010, settling in Lexington to be nearerand spend more time her family along with continuing her career with Moore Center for Orthopedics. TJ lives inGilbert with her husband David and their son John-David.
You win when you choose our teamOur highly skilled sports medicine team cares for the USC Gamecocks, weekend warriors andeveryone in between. And we’ll guide every step of your treatment — from diagnosis to recovery —so you can get back to feeling like yourself as quickly as possible.Put our innovation to work for you. Find your specialist today.Mickey F. Plymale, MDJeffrey A. Guy, MDGuillaume D. Dumont, MDMatthew R. Pollack, MDFrank K. Noojin III, MDS. Wendell Holmes Jr., MDChristopher G. Mazoué, MDS. Wendell Holmes Jr., MD, is the team physicianfor Gilbert High School.Call his office at 803-296-9260.Foot and Ankle Joint Replacement TraumaPediatric Orthopedics Interventional MedicineSpine Sports Medicine Hand and Upper Extremity803-29ORTHO PHUSCOrthoCenter.orgOfficial team physiciansfor the USC Gamecocks
Note: Complete and sign this form (with your parents if younger than 18) before your appointment.Name: Date of Birth: Sex:Date of Examination: Sport(s):List past and current medical conditions:Have you ever had surgery? If yes, list all past surgical procedures:Medicines and supplements: List all current prescriptions, over-the-counter medicines, and supplements (herbal and nutritional):Do you have any allergies? If yes, please list all your allergies (ie, medicines, pollens, food, stinging insects):General Questions.Explain “Yes” answers at the end of this form. Circle questions if you don’tknow the answer.Yes No1. Do you have any concerns that you would like to discuss withyour provider?16. Do you cough, wheeze, or have difficulty breathing during orafter exercise?18. Do you have groin or testicle pain or a painful bulge or hernia in thegroin area?3. Do you have any ongoing medical issues or recent illness?YesNo4. Have you ever passed out or nearly passed out DURING orAFTER exercise?19. Do you have any recurring skin rashes or rashes that come andgo, including herpes or methicillin-resistant Staphylococcusaureus (MRSA)?20. Have you ever had a concussion or head injury that causedconfusion, a prolonged headache, or memory problems?5. Have you ever had discomfort, pain, tightness, or pressure inyour chest during exercise?6. Does your heart ever race, flutter in your chest or skip beats(irregular beats) during exercise?21. Have you ever had numbness, tingling, or weakness in your armsor leg, or been unable to move your arms or legs after being hitor falling?7. Has a doctor ever told you that you have any heart problems?22. Have you ever become ill while exercising in the heat?8. Has a doctor ever ordered a test for your heart? (for exampleElectrocardiography (ECG) or echocardiography.23. Do you or someone in your family have sickle cell trait or disease?24. Have you ever had or do you have any problems with your eyesor vision?9. Do you get lightheaded or feel shorter of breath than your friendsduring exercise?25. Do you worry about your weight?10. Have you ever had a seizure?Health Questions About Your FamilyYes No28. Have you ever had an eating disorder?Females Only12. Does anyone in your family have a genetic heart problem such ashypertrophic cardiomyopathy, Marfan syndrome, arrhythmogenic right ventricular cardiomyopathy (ARVC), long QTsyndrome(LQTS), short QT syndrome (SQTS), Brugada syndrome, orcatecholaminergic polymorphic ventricular tachycardia (CPVT)?15. Do you have a bone, muscle, ligament or joint injury that bothersyou?Yes No29. Have you ever had a menstrual period?30. How old were you when you had your first menstrual period?31. When was your most recent menstrual period?13. Does anyone in your family had a pacemaker or implantedDefibrillator before age 35?14. Have you ever had a stress fracture or an injury to a bone,muscle, ligament, joint or tendon that caused you to miss a gameor practice?26. Are you trying to or has anyone recommended that you gain orlose weight?27. Are you on a special Diet or do you avoid certain types of foods?11. Has any family member or relative died of heart problems or hadan unexpected or unexplained sudden death before age 35(including drowning or unexplained car accident)?Bone and Joint QuestionsYes No17. Are you missing a kidney, an eye, a testicle (males), your spleen,or any other organ?2. Has a provider ever denied or restricted your participation insports for any reason?Heart Heath Questions About YouMedical Questions32. How many periods have you had in the past 12 months?Yes NoExplain a “Yes” answer here:I hereby state that, to the best of my knowledge, my answers to the questions on this form are complete and correct.Signature of athlete:Signature of parent or guardian:Date 2019 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Societyfor Sports Medicine, and American Osteopathic Academy od Sports Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgement.
Last NameFirst NameMiddle InitialDate of R 20/MedicalL 20/NormalCorrected Yes NoAbnormal FindingsAppearance:Marfan stigmata (kyphoscoliosis, high–arched palate, pectus excavatum, arachnodactyly, hyperlaxity,myopia, mitral valve prolapse (MVP), and aortic insufficiencyEyes / Ears / Nose / Throat- Pupils equal / HearingLymph NodesHeart- Murmurs (auscultation standing, auscultation supine, and /- Valsalva maneuverLungsAbdomenSkin- Herpes simplex virus (HSV), lesions suggestive of methicillin-resistant Staphylococcus aureus(MRSA), or tinea corporisNeurologicMusculoskeletal:- Neck- Back- Shoulders/Arm- Elbow/Forearm- Wrist/Hand/Fingers- Hip/Thighs- Knees- Leg/Ankles- Foot/Toes- Functional: Double-leg squat test, single leg squat test, and box drop or step drop testConsider: electrocardiography (ECG), echocardiography, and referral to cardiologist for abnormal cardiac history or examination findings or a combination of those.Preparticipation Physical EvaluationMedically eligible for all sports without restriction.Medically eligible for all sports without restriction with recommendations for further evaluation or treatment of:Medically eligible for certain sports:Not medically eligible pending further evaluation.Not medically eligible for any sports.Recommendations:I have examined the student named on this form and completed the preparticipation physical evaluation. The athlete doesnot have apparent clinical contraindications to practice and can participate in the sport(s) as outlined on this form. Ifconditions arise after the athlete had been cleared for participation, the physician may rescind the medical eligibility untilthe problem is resolved and the potential consequences are completely explained to the athlete and parents or guardians.Name of health care professional (print or type): Date:Address: Phone:Signature of health care professional: MD, DO, NP, or PA 2019 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Societyfor Sports Medicine, and American Osteopathic Academy od Sports Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgement.
Returning (Student/Parent) Athletic Pre-Participation Forms Registration1. Login with previous year account credentials After logging in, click on your name at the top right of the screen, and then select SettingsType in school name within the School text field, and then select the appropriate schoolUpdate any contact information such as phone, email address and mailing addressClick Save at bottom of screenBoth a parent and student are required to log back in for the new year and complete athletic formsIf you do not remember your login credentials, please utilize the Forgot Password option or contact the school athletic departmentYour school has elected to collect pre-participation forms online. Follow the steps below to re-complete pre-participation registration:2. Update Home School (If Applicable) 3. Athletic Forms buttonClick the Athletic Forms button to move to the Pre-Participation Forms Overview Page and complete the required digital forms.Make sure the Date Range is set to 2020-2021In the Sports Interest section, check the sports you will be trying out for. By checking these sports, you are allowing the coach of that team toview your pre-participation paperwork.5. Additional Schools (If Applicable)If you/your student participate in sports at multiple schools, add the additional schools here. If you/your student do not play for multipleschools, leave this section blank. Adding additional schools will allow the Athletic Director(s) at the additional school(s) view yourpre-participation paperwork.4. Select the Sports you willparticipate in6. Complete & Sign Digital FormsRe-Use Document Buttons (If Applicable) are displayed within forms that have been completed in previous years, allowing parent/studentthe ability to update necessary information prior to submitting the form for the new year.Upload Buttons are shown when you are required to upload a document instead of completing the web-form. For example, the physicalexam form your physician completes or a birth certificate. These forms can be uploaded by either the parent or student but require theparents signature.Students with accounts may begin completing digital forms immediately. Parents must be linked to a student account to see the electronicversion of the forms. If they are not linked, they will only see example PDF versions of the forms. You can complete forms or see theirstatus at any time by clicking on the ATHLETIC FORMS button. This gives the ability for students to send a parent linked account requestand to upload the physical exam signed by the physician during group physicals.Click on each form link, complete each form, and click the Sign & Submit button. Both the parent and student must complete this step.Your school/district chooses which forms require the student, parent, or student AND parent signatures. Upon completion of each form,you should be auto promoted to the next form.7. Accepted Forms NotificationWhen your school has accepted all forms, a notification will be sent to you stating all forms have been accepted. You will be notified viaemail and/or text message (if you have selected the text message option during account creation), if a form has been denied by yourschool. You will be sent a notification, in which you will be given the reason for denial and a link to review and resubmit your changes backto the school.If you need assistance with PlanetHS or need more information, please consult the help documents found here https://schoolsupport.helpdocs.com or email schoolsupport@planeths.com. If youhave questions regarding the content of form requirements, please contact your school Athletic Director.(PHS) Parent & Student Getting Started V1 03.29.19
Science and Sports Medicine courses. She is nationally certified as an athletic trainer by the Board of Certification for Athletic Training, as well as the State of South Carolina. Emily received her athletic training degree from Western Carolina University and M.S. from the University of South Carolina.
