Participant Medical Information
Medical Information Forms
The University of Michigan requires four standardized
forms (provided as one set) to be completed for each youth participant
(17 years and younger) attending your program. These
medical and liability forms have been reviewed and
approved by U-M Risk Management and the Office of
the General Counsel.
Quick access to important medical information by
the Department of Public Safety and Housing Security
officers is critical when assisting in an emergency,
especially evening, weekend or nighttime hours.
Copies of the Parental Consent and Release of Liability
Agreement, Health Insurance Information Sheet and
the Emergency Information Form should be placed in
a binder or folder with the name of your program.
The binders or folder should be kept with your program’s
resident staff.
Your participants should report to your resident staff
first with medical concerns. The Department of Public
Safety personnel make the determination to call for
further medical assistance (ambulance), if needed.
In the event of an emergency, the responding officer
will need access to these forms to send to the hospital
or treatment center.
Forms may be obtained by contacting the Conference
Services at 734.764.5297 or by email at conferences@umich.edu
If you have any questions about the medical and/or
liability forms or the process, please contact:
Kate Rychlinski, Assistant Risk Manager
U-M Risk Management
734.764.2200
kmrychli@umich.edu
Medication
Parents or guardians of youth participants 17 years
of age and younger must give authorization to dispense
any scheduled medication.
- The name of the medication.
- The dosage of the medication.
- The name and telephone number of the prescribing physician. The telephone number of the physician must be on record.
Questions?
If you have any questions about the forms or the process, please contact:
Kate Rychlinski
U-M Risk Management
734.764.2200 |
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