[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-283635-105":3,"detail-sidebar-cat-1-en-105":81,"doc-detail-283635-en":126},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","aiba-medical-certificate-medical-certificate-template","AIBA Medical Certificate - Medical Certificate Template","","AIBA medical certificate template for athletes covers personal information, doctor details, and required athlete questions related to current treatment, past concussion or unconsciousness, recent head impacts, headaches, bleeding problems, viral infections, family medical history, surgeries, hospital stays, and existing conditions. It includes concussion-related certification language, a structured general medical examination with system-by-system checks and an abnormalities section, plus allergy and medication recording. The form also captures whether TUE has been submitted.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/aiba-medical-certificate-medical-certificate-template/283635/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/aiba-medical-certificate-medical-certificate-template/283635.png","ImageObject",442,249,{"name":42,"@type":43},"Ava Thompson","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-30","2026-09-17",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",12,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What information must be provided for the athlete and doctor on this medical certificate?","Question",{"text":63,"@type":64},"The form requests athlete name, date of birth, signature, and date, along with doctor name, title/position, address, signature, stamp, and date. It also includes a comments section.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What questions does the athlete need to answer?",{"text":68,"@type":64},"The athlete must answer whether a doctor is currently treating them, whether they have ever been unconscious or had a concussion, whether they were hit hard in the head in the last 6 weeks, and whether they have had headaches in the last 2 weeks. Additional questions cover bleeding problems, hepatitis B/C or HIV history, family disease or sudden unexpected deaths, past surgery, hospital stay, and any medical condition.",{"name":70,"@type":61,"acceptedAnswer":71},"How does the document record medical examination results and abnormalities?",{"text":72,"@type":64},"It provides a medical examination table with system-by-system evaluation (e.g., mental status/psychological, head/vision, mouth/teeth/throat, ears, neck, chest, cardiovascular, orthopaedic, neurological, allergies, and medications). For each item, the doctor can mark Normal or Abnormal, with a dedicated abnormalities area as needed.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},283635,1790363021,{"code":4,"msg":82,"data":83},"success",[84,89,93,98,103,108,112,117,122],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":55,"doc_module":22,"doc_module_name":25,"category_name":90,"show_sort_weight":91,"slug":92},"Resumes",80,"resumes",{"id":94,"doc_module":22,"doc_module_name":25,"category_name":95,"show_sort_weight":96,"slug":97},14,"Invoices",70,"invoices",{"id":99,"doc_module":22,"doc_module_name":25,"category_name":100,"show_sort_weight":101,"slug":102},15,"Posters",60,"posters",{"id":104,"doc_module":22,"doc_module_name":25,"category_name":105,"show_sort_weight":106,"slug":107},16,"Social Media",50,"social-media",{"id":109,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":110,"slug":111},17,40,"forms",{"id":113,"doc_module":22,"doc_module_name":25,"category_name":114,"show_sort_weight":115,"slug":116},18,"Letters",30,"letters",{"id":118,"doc_module":22,"doc_module_name":25,"category_name":119,"show_sort_weight":120,"slug":121},21,"Paper Templates",5,"papers-templates",{"id":123,"doc_module":22,"doc_module_name":25,"category_name":124,"show_sort_weight":4,"slug":125},158,"General","general-158",{"code":4,"msg":82,"data":127},{"doc_id":79,"user_id":128,"nickname":42,"user_avatar":129,"doc_module":22,"category_id":109,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":30,"language":135,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":12,"update_tm":139,"read_time":22},1649267921044,"https://us-avatar.wpscdn.com/avatar/1800007509477c92dfb?_k=1786009248482753345","APPENDIX 5: MEDICAL CERTIFICATE TEMPLATE  \nAthlete  \nNAME:     \nDATE OF BIRTH:    \nSIGNATURE:   DATE:    \n\n| NAME:\u003Cbr>TITLE/POSITION:\u003Cbr>ADDRESS:\u003Cbr>SIGNATURE:\u003Cbr>STAMP\u003Cbr>COMMENTS: | Doctor |\n| --- | --- |\n|  |  |\n|  |  |\n|  | DATE: |\n|  |  |\n|  |  |\n|  |  |\n\nFit to Box Not Fit to Box  \nAIBA Medical Certificate Page 1/3  \n\n| QUESTION FOR ATHLETE: IF YES, EXPLAIN\u003Cbr>1. Is a Doctor currently treating you for anything? |\n| --- |\n| 2. Have you ever been unconscious or had a concussion? |\n| 3. Have you been hit hard in the head in the last 6 weeks? |\n| 4. Have you had any headache in the last 2 weeks? |\n| 5. Do you have any problem with bleeding? |\n| 6. Do you have a history of hepatitis B or hepatitis C or HIV infection? |\n| 7. Does any disease run in your family? Sudden unexpected deaths? |\n| 8. Have you had any surgery? |\n| 9. Have you ever had to stay in a hospital? |\n| 10. Do you have any medical condition? |\n|  |\n\nAIBA Medical Certificate Page 2/3  \n\n| MEDICAL CERTIFICATE |  |  |  | ABNORMALITIES |\n| --- | --- | --- | --- | --- |\n| If Athlete had a Concussion in the past year, please certify that: | Medical Examination following rest period after Concussion was normal Athlete Fit To Box | Normal | Abnormal |  |\n| General Medical Exam | List abnormalities not covered in specific system exams below: |  |  |  |\n| Mental Status/ Psychological | Brief survey | Normal | Abnormal |  |\n| Head | Cranial nerves, eyes, pupil size and reactivity, Fundi, vision by chart (record) | Normal | Abnormal |  |\n|  | Mouth, teeth, throat | Normal | Abnormal |  |\n|  | Ears | Normal | Abnormal |  |\n|  | Temporomandibular joint | Normal | Abnormal |  |\n| Neck | Cervical spine, lymph nodes | Normal | Abnormal |  |\n| Chest | Breath sounds, rib\u003Cbr>tenderness on compression | Normal | Abnormal |  |\n| Cardio Vascular System | Pulse/blood pressure (record) | Normal | Abnormal |  |\n|  | Heart examination: sounds, murmurs, heaves, size, rhythm | Normal | Abnormal |  |\n| Orthopaedic System | Upper limb: shoulder, wrist, hand, fingers | Normal | Abnormal |  |\n|  | Lower limb: foot, ankle, knee, hip | Normal | Abnormal |  |\n| Neurological System | Reflexes | Normal | Abnormal |  |\n|  | Verbal Responses | Normal | Abnormal |  |\n|  | Motor responses and balance | Normal | Abnormal |  |\n| Allergies | (record) | Yes | No |  |\n|  | Type of reaction (record) |  |  |  |\n| Medications used | Name and dosage (record) | Yes | No |  |\n\nAny TUE Submitted?  \n No  \nYes (If yes, please explain)  \nAIBA Medical Certificate Page 3/3","cbCaihhzOSzCpZZI","https://ap.wps.com/l/cbCaihhzOSzCpZZI","pdf",1140469,"English","# Appendix 5: Medical Certificate Template\n## Athlete Information and Doctor Details\n## Athlete Questionnaire\n## Medical Certificate Examination and Abnormalities\n## TUE Declaration","[{\"question\":\"What information must be provided for the athlete and doctor on this medical certificate?\",\"answer\":\"The form requests athlete name, date of birth, signature, and date, along with doctor name, title/position, address, signature, stamp, and date. It also includes a comments section.\"},{\"question\":\"What questions does the athlete need to answer?\",\"answer\":\"The athlete must answer whether a doctor is currently treating them, whether they have ever been unconscious or had a concussion, whether they were hit hard in the head in the last 6 weeks, and whether they have had headaches in the last 2 weeks. Additional questions cover bleeding problems, hepatitis B/C or HIV history, family disease or sudden unexpected deaths, past surgery, hospital stay, and any medical condition.\"},{\"question\":\"How does the document record medical examination results and abnormalities?\",\"answer\":\"It provides a medical examination table with system-by-system evaluation (e.g., mental status/psychological, head/vision, mouth/teeth/throat, ears, neck, chest, cardiovascular, orthopaedic, neurological, allergies, and medications). For each item, the doctor can mark Normal or Abnormal, with a dedicated abnormalities area as needed.\"}]","AIBA Medical Certificate - Medical Certificate Template | PDF",1789615285]