Download the sports medicine clinic schedule is as follows

SPORTS MEDICINE CENTER
The Sports Medicine Center will open for the 2014-2015 Session
SATURDAY, AUGUST 9, 2014
The Registration area is open from 6:00 a.m. – 9:00 a.m. each Saturday listed below.
Please register in the Admissions Department on the
11th Floor of the Nix Medical Center.
The Sports Medicine Center is located on the 11th Floor, Suite 1116.
Physician examinations begin at 7:00 a.m.
PARKING:
Complimentary Parking is available in the Nix Medical Center Valet Parking located at 414 Navarro San Antonio,
Texas 78205
Two hour free parking is also available with validation at the Houston Street Garage, located at the corner of
College Street and Navarro.
Other Parking (validation NOT available) is located at South Bank Lot at the corner of Navarro and Crockett
Street.
AUGUST
9
16
23
30
THE SPORTS MEDICINE CLINIC SCHEDULE IS AS FOLLOWS:
SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY FEBRUARY MARCH APRIL
6
13
20
27
4
11
18
25
1
8
15
22
6
13
20
10
24
7
21
7
21
11
18
MAY
2
16
30
FROM IH-37 / 281,
Exit Commerce,
Go west on Commerce
Turn right on Navarro.
FROM IH-10 EAST,
Exit Durango Blvd./Downtown.
Turn right on Durango.
Turn left on Santa Rosa.
Turn right on Dolorosa (turns into Market Street).
Turn left on Navarro.
FROM IH-35 / IH-10 WEST,
Exit Santa Rosa Street/Downtown.
Turn left on Dolorosa (turns into Market Street).
Turn left on Navarro.
Please contact RAUL GARCIA; Clinic Coordinator, if you need assistance at:
(210) 579-3416
SPORTS MEDICINE CENTER
What each student should know or have BEFORE coming to the Nix Sports Medicine Center:
WHAT YOU SHOULD KNOW:

Name

Address

Date of Birth

**Social Security Number

Home Phone Number

Mom or Dad’s name, employer, & work phone number

Name of school you attend

Athletic trainer’s or coach’s name
WHAT YOU SHOULD HAVE:

A parent, guardian, athletic trainer or coach present with you at the Sports Clinic

Proof of Insurance – whether it be school insurance or personal insurance

If you have school insurance, your MUST have a signed form by one of your parents.

If any X-rays or MRIs were done before your visit to the Sports Clinic, be sure to bring
a copy of the films with the report.

A completed Student Claim Form from your school.
If you have any questions regarding any of the above, please call:
Raul Garcia, Clinic Coordinator
(210) 579-3416
(210) 579-3382 Fax
SPORTS MEDICINE CENTER
Free evaluation of sports related injuries is provided by
orthopaedic surgeons, primary care and pediatric
physicians who specialize in sports medicine. The
evaluations are free because these physicians volunteer
hundreds of hours each year at the
Nix Sports Medicine Center.
However, diagnostic testing such as x-ray, MRI, or
CT-scans is not included as part of the complementary
evaluation. The athlete must pay any applicable insurance
co-payment, deductibles, and services not covered by
insurance. If the student does not have insurance coverage
Nix Health will work with the student and the families on
a payment plan and/or other arrangements can be made.
414 Navarro, Suite 1116
▬
San Antonio, TX 78205
▬
(210) 579-3416
▬
(210) 579-3382 Fax
PATIENT NUMBER: _____________________
DATE:________________________________
TIME IN: _________________ TIME OUT: __________________
MR# ___________________ ACCT# ______________________
Type of Visit: NP  F/U  F/U-NI 
W  B  H  O 
SPORTS MEDICINE CENTER
1. Patient Name
SS#
FIRST:
LAST
-
-
Date of Birth
/
Injury:
MI:
/
Sex:  M  F
Age:
(RT / LT) Date of Injury:
Sport:
Marital Status:  Single  Married
School Address:
City:
Zip:
2. Parent Name:
Phone:
Relationship: Father / Mother / Other
Address:
City:
Zip:
Phone:
Name of Guarantor:
SS# of Guarantor: ___________ - _______ - ___________
Address of Guarantor:
Guarantor Date of Birth: _________ /________ / ________
Guarantor Employer:
Work Phone:
Employer Address:
(please indicate if: Retired/Disabled/Unemployed)
Insurance Information (Attach copy of Card) Primary Insurance:
Policy #:
Group #:
Secondary Insurance:
3. SCHOOL:
Name of Coach/Trainer:
DISTRICT:
Phone:
HISTORY & PHYSICAL FINDINGS:
Allergies:
Significant Past History:
Bleeding Tendency:
Medications:
DIAGNOSIS:
PLAN:
 X-ray of:
 Cast
 Brace
 MRI of:
 other RAD:
 Other Appliance
 Other
ACTIVITY:
 Return to play with no restrictions
 No return to play until released
 Return to play with the following restrictions:
PHYSICIAN’S SIGNATURE:
 Jesse Delee, MD 351-6500
 Mark Casillas, MD 224-2655
 Matthew Murray, MD 450-0577
DATE:
 John Evans, MD 351-6500
 Zachary Stinson, MD 351-6500
 Rodolfo Navarro, MD 567-4552
 Philip M. Jacobs, MD 804-5491
 Jeremy Dickerson, MD 224-2655
 Ryane Galindo, PA 224-2655
414 Navarro Street, Suite 1116 | San Antonio, TX 78205 | (210) 579-3416 | (210) 579-3382 (fax)
Rev. 08/06/2014