• Donor Family / Living Donor Athlete Medical Form

    Please note that your medical forms must be completed ONLINE here.

    You MUST visit the Doctor-in-charge of your care in order to get your accurate medical data and ensure that your Doctor is happy for you to compete in your chosen sports. Completion of these forms confirms that you have indeed visited your doctor to obtain this information.

    Medical Forms must be submitted by the close of Registrations (12th January 2024).

    The information on your medical forms will be reviewed prior to confirmation of your ability to compete. If the information is incomplete you will not be allowed to participate in the Games.

    Before competing in the World Transplant Winter Games, it is expected that your general health and fitness are stable as judged by your doctor. Your health is to be measured by the tests performed by your follow-up doctor and, if necessary, your follow-up cardiologist or sports doctor. You are responsible for maintaining your own training program, preferably in conjunction with a sporting advisor/coach.

    You should adapt your training program to match your chosen sports. The 3 stress levels are shown below:

    LOW STRESS:

    *  Curling

     

    MEDIUM STRESS:

    * Snowshoe Individual

     

    HIGH STRESS:

    * Ski Slalom / Ski Giant Slalom / Ski Super Giant Slalom / Ski Parallel Slalom

    * Snowboard Giant Slalom / Snowboard Parallel Slalom

    * Cross Country Ski 5km / Cross Country Ski 1 hour 

    * Biathlon

             

  • COMPETITOR DETAILS

  • Date of Birth: *
     / /
  • Gender*

  • DONOR DETAILS

  • Are you a Living Donor?*
  • If YES, Organ or tissue donated?
  • Date of donation
     - -
  • Are you a family member of a deceased donor?*
  • Are you a family member of a living donor?*

  • FITNESS INFORMATION

  • *I certify that I take part in regular physical activity as follows: 

  • I am training at a stress level of:*

  • MEDICAL INFORMATION

  • Rows
  • Do you have a respiratory disease?*
  • Do you have a history of COVID-19 Infection*
  • If yes, provide date of last infection
     - -
  • Date of last dose?
     - -

  • CARDIAC STRESS TEST

  • A cardiac stress test is not essential in those with a history of coronary artery disease or over the age of 50 undertaking medium and high stress sports events.

    However, it may be recommended by your local physician in appropriate cases and if performed the results should be declared below.

  • Will you be completing a cardiac stress test?*
  • Rows

  • ** Upload a copy of your Cardiac Stress Test results below **

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  • CURRENT MEDICATION

  • Rows

  • MEDICAL DOCTORS DETAILS

  • Date of consultation*
     / /
  • I confirm that my medical doctor carried out an examination at the date of consultation indicated above, agreed I am fit to compete in my selected events, and provided me with all the medical information required in this document.*

  • Data Storage and Participation in Clinical Research

    Please note that all relevant GDPR requirements will be followed in the management of medical forms.
  • I am willing to be approached to participate in clinical research during the World Transplant Winter Games 2024?*
  • I agree that after the Games my data may be stored in a non-identifiable format and may be used for future studies by the World Transplant Games Federation authorised researchers?*

  • DECLARATION

    I confirm that the information provided is true and accurate to the best of my knowledge and, where required, information is provided by a qualified medical doctor.
  • Date*
     / /
  • Should be Empty: