Each of the following forms should be downloaded (pdf format), printed, and completed, as per
the accompanying instructions contained in the Student Injury Procedures and Student Injury Checklist:
Student Injury Procedures
Student Injury Checklist
Student Injury Worksheet
If a student is injured with a contaminated sharp instrument, the following form must also be downloaded (pdf format), printed, and completed:
TDSHS Contaminated Sharps Injury Reporting Form
In addition, if the student requires medical treatment as a result of a clinical accident/injury, the following form must be downloaded (pdf format), printed, and completed and signed (Section 1), and must accompany the student when he/she seeks initial treatment AND each time he/she receives follow-up care:
Hartford Insurance claim form
This form, once completed and signed by the medical provider, must be submitted to Tania Howard in order for the claim to be processed for the purpose of reimbursement for medical treatment received by the injured student. Failure to submit the completed form will result in non-reimbursement for medical expenses.
An official Amarillo College Student Identification badge must be presented, at the time of service, if a student elects to seek treatment at Concentra Health Services.
Last updated by Kim Lacey -- Nov/08/12