Homepage Free Alabama High School Physical PDF Template
Outline

Understanding the Alabama High School Athletic Association (AHSAA) Preparticipation Physical Evaluation Form is critical for students wishing to engage in interscholastic athletics. This comprehensive form serves a dual purpose of confirming a student's medical eligibility and ensuring their safety during sports participation. The process begins with a detailed history section where the student, alongside a parent or guardian, discloses any past injuries, conditions, or medical concerns that might affect their participation in sports - covering aspects from allergies and medications to previous hospitalizations and surgeries. Importantly, the form requires honest disclosure about menstrual history, previous diagnoses such as asthma or diabetes, and any past incidents of concussions or bone fractures, which could influence an athlete's capacity to compete safely. Following this, a physical examination conducted by a licensed physician evaluates the student's current health status across various parameters including cardiovascular health, musculoskeletal condition, and overall fitness, leading to one of three clearances: full clearance, clearance after further evaluation or rehabilitation, or not cleared for sports participation due to specific medical concerns. This evaluation, validated by the physician's signature, must be renewed annually, signifying its importance in the ongoing health monitoring of high school athletes. The enforcement of this form by the AHSAA underlines the organization’s dedication to safeguarding student-athletes' health and well-being while fostering a secure and inclusive environment for interscholastic sports competition.

Document Preview

ALABAMA HIGH SCHOOL ATHLETIC ASSOCIATION

Revised 2018

Revised 2018

Preparticipation Physical Evaluation Form

 

History

Date_______________________

Name__________________________________________________ Sex ________ Age______ Date of birth _______________

Address ______________________________________________________________________ Phone______________________

School ________________________________________________________Grade __________ Sport ______________________

Explain “Yes” answers below:

 

 

 

 

 

Yes

No

1.

Has a doctor ever restricted/denied your participation in sports?

 

 

 

 

 

2.

Have you ever been hospitalized or spent a night in a hospital?

 

 

 

 

 

 

Have ever had surgery?

 

 

 

 

 

 

 

 

3.

Do you have any ongoing medical conditions (like Diabetes or Asthma)?

 

 

 

 

4.

Are you presently taking any medications or pills (prescription or over‐the‐counter?

 

5.

Do you have any allergies (medicine, pollens, foods, bees or other stinging insects)?

 

6.

Have you ever passed out during or after exercise?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Have you ever been dizzy during or after exercise?

 

 

 

 

 

 

 

 

Have you ever had chest pain or discomfort in your chest during or after exercise?

 

 

Do you tire more quickly than your friends during exercise?

 

 

 

 

 

 

 

Have you ever had high blood pressure?

 

 

 

 

 

 

 

 

Have you ever been told that you have a heart murmur, high cholesterol, or heart infection?

 

 

Have you ever had racing of your heart or skipped heartbeats?

 

 

 

 

 

 

Has anyone in your family died of heart problems or a sudden death before age 50?

 

 

Does anyone in your family have a heart condition?

 

 

 

 

 

 

 

Has a doctor ever ordered a test on your heart (EKG, echocardiogram)?

 

 

 

 

7.

Do you have any skin problems (itching, rashes, staph, MRSA, acne)?

 

 

 

 

 

8.

Have you ever had a head injury or concussion?

 

 

 

 

 

 

 

 

Have you ever been knocked out or unconscious?

 

 

 

 

 

 

 

 

Have you ever had a seizure?

 

 

 

 

 

 

 

 

 

Have you ever had a stinger, burner, pinched nerve, or loss of feeling or weakness in your arms or legs?

 

9.

Have you ever had heat or muscle cramps?

 

 

 

 

 

 

 

 

Have you ever been dizzy or passed out in the heat?

 

 

 

 

 

 

10. Do you have trouble breathing or do you cough during or after activity?

 

 

 

 

 

Do you take any medications for asthma (for instance, inhalers)?

 

 

 

 

 

11. Do you use any special equipment (pads, braces, neck rolls, mouth guard, eye guards, etc.)?

 

12. Have you had any problems with your eyes or vision?

 

 

 

 

 

 

 

Do you wear glasses or contacts or protective eye wear?

 

 

 

 

 

 

13. Have you had any other medical problems (infectious mononucleosis, diabetes, infectious diseases, etc.)?

 

14. Have you had a medical problem or injury since your last evaluation?

 

 

 

 

 

15. Have you ever been told you have sickle cell trait?

 

 

 

 

 

 

 

 

Has anyone in your family had sickle cell disease or sickle cell trait?

 

 

 

 

 

16. Have you ever sprained/strained, dislocated, fractured, broken or had repeated swelling or other

 

 

injuries of any bones or joints?

 

 

 

 

 

 

 

 

 

Head

Back

Shoulder

Forearm

Hand

Hip

Knee

Ankle

 

 

Neck

Chest

Elbow

Wrist

Finger

Thigh

Shin

Foot

 

17.When was your first menstrual period?__________________________________________________________________

When was your last menstrual period?___________________________________________________________________

What was the longest time between your periods last year?________________________________________________

Explain “Yes” answers:

______________________________________________________________________________________________________________

______________________________________________________________________________________________________________

______________________________________________________________________________________________________________

______________________________________________________________________________________________________________

______________________________________________________________________________________________________________

I hereby state that, to the best of my knowledge, my answers to the above questions are correct.

Signature of athlete ___________________________________________________________ Date ___________________

Signature of parent/guardian __________________________________________________

FORM 5

DUPLICATE AS NEEDED

Rev. 2018 (The revised 2018 form is the official form accepted by the AHSAA.)

Page 1 of 2

Preparticipation Physical Evaluation Rule 1, Sec. 14 — In order for a student to be eligible for interscholastic athletics, there must be

on file in the Superintendent’s or Principal’s office a current physician’s statement certifying that

__________________________________________ the student has passed a physical exam, and that in the opinion of the examining physician (M.D.

 

 

 

Student's name

or D.O.) the student is fully able to participate in interscholastic athletics (Grade s 7‐12). The

 

 

 

AHSAA Physicians Certificate (Form 5 Rev. 2018) must be used. A physical exam will satisfy the

 

 

 

 

 

Physical Examination

requirement for one calendar year through the end of the month from the date of the exam. For

example, a physical given on May 5, 2019, will satisfy the requirement through May 31, 2020.

 

 

 

 

 

 

 

 

 

 

Height ____________ Weight _____________ BP _____ / _____ Pulse ____________

 

 

 

 

Vision R 20 / ____ L 20 / ____ Corrected: Y N

Revised 2018

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LIMITED

 

Normal

 

 

Abnormal Findings

 

 

 

 

 

 

 

 

 

 

 

Cardiovascular

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pulses

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Heart

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lungs

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Skin

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E.N.T.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMPLETE

 

Abdominal

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Genitalia (males)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Musculoskeletal

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Neck

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Shoulder

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Elbow

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Wrist

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hand

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Back

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Knee

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ankle

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Foot

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Clearance:

A.Cleared

B.Cleared after completing evaluation/rehabilitation for: _______________________________________

C. Not cleared for:

Collision

 

 

 

Contact

 

 

 

Noncontact ____ Strenuous

____ Moderately strenuous

____ Nonstrenuous

Due to: ____________________________________________________________________________________________

Recommendation: _________________________________________________________________________________________

________________________________________________________________________________________________________

________________________________________________________________________________________________________

Name of physician ________________________________________________________________ Date ____________________

Address ________________________________________________________________________ Phone___________________

.

Signature of physician _____________________________________________________________, M.D. or D.O.

(Form must be signed and dated by the attending physician.)

Rev. 2018 (The revised 2018 form is the official form accepted by the AHSAA.)

Document Attributes

Fact Number Detail
1 The form is designated for Alabama High School Athletic Association (AHSAA) Preparticipation Physical Evaluation.
2 It includes sections on athlete's history, including medical, injuries, allergies, and conditions.
3 Physical Examination section assesses various health aspects, such as Musculoskeletal, Cardiovascular, and more.
4 Governing law: AHSAA Rule 1, Sec. 14 requires a current physical exam for eligibility in interscholastic athletics for grades 7-12.
5 The physical exam is valid for one calendar year from the date of examination.
6 Clearance categories include: Cleared, Cleared after evaluation/rehabilitation, and Not cleared, with reasons and recommendations provided.
7 Mandatory signatures include that of the athlete, parent/guardian, and examining physician (M.D. or D.O.).
8 Form must be on file in the Superintendent's or Principal's office to fulfill eligibility requirements.
9 Includes a directive to explain any "Yes" answers in detail for certain sections, enhancing understanding of athlete’s health condition.
10 The form serves as a comprehensive tool to ensure athlete safety and readiness for participation in sports activities.

How to Fill Out Alabama High School Physical

Filling out the Alabama High School Physical Form is a crucial step for student-athletes wishing to participate in interscholastic athletics. This form ensures that all athletes are physically capable of taking part in sports activities, safeguarding their health and well-being. To complete this form properly, both student information and a detailed medical history must be provided. The form also requires a physical examination by a certified physician, who will give their clearance based on the health assessment. After completing this process, the form should be kept on file as per the Alabama High School Athletic Association's guidelines. Follow these steps to ensure the form is filled out accurately and thoroughly.

  1. Start with the History section by entering the student's full name, sex, age, address, school, and grade.
  2. Proceed to fill out the detailed medical history. This includes checking boxes and providing explanations for any 'Yes' answers regarding past medical issues, allergies, injuries, and other health-related questions.
  3. Indicate the student-athlete's participation in sports by marking the appropriate sport(s) box(es).
  4. Complete the section on menstrual history if applicable, including details on the last period and any irregularities.
  5. Sign and date the form at the bottom of the first page, confirming the accuracy of the provided information. The parent or guardian must also sign and date the form.
  6. On the second page, under the Physical Examination section, a physician must record findings from the physical exam, including vital signs, height, weight, and evaluations of various physical functions and areas.
  7. Based on the examination, the physician will check one of the clearance options and note any recommendations for further evaluation, rehabilitation, or restrictions on physical activity.
  8. The physician must then provide their name, address, phone number, and signature at the bottom of the page, along with the date of the exam.

After completing these steps, ensure the form is copied and the original is kept securely in the school’s Superintendent's or Principal's office. This will maintain the eligibility of the student-athlete for participation in sports activities for one calendar year from the date of the physical examination. It’s important that this process is followed carefully to ensure the safety and eligibility of all student-athletes.

More About Alabama High School Physical

  1. What is the purpose of the Alabama High School Athletic Association Preparticipation Physical Evaluation Form?

    This form is designed to ensure that students in grades 7-12 who wish to participate in interscholastic athletics are medically able to do so. It requires a thorough medical history and a physical examination to identify any conditions that might affect the student's ability to safely engage in sports activities. The examining physician must certify that the student is fully able to participate in interscholastic athletics.

  2. Who needs to complete the Alabama High School Physical Form?

    Any student in grades 7 through 12 attending an Alabama high school who wishes to participate in interscholastic athletic programs must have this form completed. Both parts, the medical history and the physical examination, are necessary. The student and a parent or guardian must sign the form, attesting to the accuracy of the provided medical history.

  3. What information is required on the form?

    The form consists of two main sections: the medical history and the physical examination. The medical history requires details about the student's general health, past injuries or conditions, medications, and any history of surgeries or hospitalizations. Specific questions about health conditions related to athletic participation are also included. The physical examination covers a range of tests and checks, from cardiovascular and musculoskeletal assessments to evaluations of the lungs, skin, and weight. The form concludes with the physician's clearance, noting whether the student is cleared for sports participation.

  4. How long is the physical examination valid?

    A physical examination for interscholastic athletics is valid for one calendar year from the date of the exam. This means that the student will need to undergo a physical examination annually to continue participating in athletic programs.

  5. What happens if a student is not cleared for participation?

    If a student is not cleared for participation, the form will indicate the specific reasons and recommendations. These could range from the need for further evaluation or rehabilitation for certain conditions to a complete restriction from collision, contact, or non-contact sports. The recommendations might include specific actions or treatments required before the student can be cleared for participation. Follow-up with the examining physician and compliance with the recommended actions are necessary steps to potentially getting cleared for future participation.

Common mistakes

  1. Not providing detailed explanations for any "Yes" answers on the history section. It is crucial to describe specific medical conditions, injuries, or concerns to ensure a thorough understanding of the athlete’s health.

  2. Failing to accurately report the medical history, including previous surgeries, ongoing medical conditions (such as asthma, diabetes, or allergies), and any episodes of being hospitalized or restricted from sports participation.

  3. Omitting information about the use of any medication, whether prescription or over-the-counter, that the athlete is taking which could affect their ability to safely participate in sports activities.

  4. Skipping details about family history that could impact the athlete's health, especially conditions like heart issues or sickle cell trait which may have implications for sports participation.

  5. Incorrectly filling out the athlete’s personal information, such as date of birth, grade, or contact details, which are vital for identification and communication purposes.

  6. Not obtaining the required signatures from both the athlete and a parent or guardian to verify the accuracy of the information provided and to consent to participation.

  7. Overlooking the physician's clearance section, which must be completed by the examining physician (M.D. or D.O.) to certify that the athlete is eligible to participate in interscholastic athletics based on the physical examination findings.

Here are additional common errors:

  • Ignoring instructions to explain certain "Yes" answers in detail, resulting in incomplete health information.
  • Missing the date of the examination, which is essential to determine the validity of the physical within the calendar year for athletic eligibility.
  • Neglecting to specify restrictions or recommendations made by the examining physician, especially if the athlete is cleared for participation with conditions or requires further evaluation.

Documents used along the form

The Alabama High School Athletic Association (AHSAA) Preparticipation Physical Evaluation Form is essential for assessing the health and fitness of students to participate in high school sports. Beyond the physical form, several other documents are frequently used to ensure a student's readiness and safety in high school athletics. These documents support a comprehensive understanding of the student's medical background, consent for participation, and awareness of risks associated with sports.

  • Emergency Medical Authorization Form: This form collects important medical information and emergency contacts. It authorizes medical treatment in case the athlete requires immediate care, and parents or guardians are not available to give consent.
  • Concussion Information Form: Required by many states, including Alabama, this form educates students and parents about the risks, symptoms, and treatment of concussions. It often requires a signature to acknowledge understanding and receipt of the information.
  • Cardiac Arrest Awareness Form: Similar to the concussion form, this document provides vital information about recognizing and responding to signs of sudden cardiac arrest in young athletes.
  • Student-Athlete Contract: This document outlines the expectations, behavior, and academic standards that student-athletes must adhere to. Signing this contract signifies the student and parents' agreement to these terms.
  • Insurance Verification Form: Verifies that the student has adequate medical insurance coverage. It may require specifics about the insurance provider and policy number.
  • Acknowledgement of Rules Form: Ensures that students and parents are aware of the school's and athletic association's rules and guidelines for participation in sports. It often includes policies on drug use, sportsmanship, and academic performance.
  • Travel Release Form: For teams that travel, this form provides permission for students to travel with the team to away games or events. It can also outline arrangements for transportation and accommodations.

Collectively, these documents, alongside the Alabama High School Athletic Association Preparticipation Physical Evaluation Form, play a crucial role in safeguarding the well-being of high school athletes. They ensure that students, parents, and guardians are well-informed about the participation in high school sports, including the benefits and inherent risks. Additionally, they facilitate prompt and appropriate responses in case of emergencies and help to uphold the values of sportsmanship and academic excellence in student-athletes.

Similar forms

  • Pre-Employment Physical Examination Forms: Similar to the Alabama High School Physical Form, these pre-employment forms assess an individual's physical ability to perform job-related duties. Both forms include a history section, physical examination findings, and a physician's clearance, ensuring the participant's capability to safely engage in specified activities, whether for sports or employment.

  • College Sports Physical Forms: These forms closely resemble the high school version, gathering detailed medical history, conducting a comprehensive physical exam, and determining eligibility for participation in collegiate sports. The key similarity lies in the structured approach to evaluating an athlete's physical readiness and the requirement for a physician's clearance.

  • Annual Health Assessment Forms for Pediatric Patients: Pediatric health assessments serve to monitor a child's development and general health status annually. Like the Alabama High School Physical Form, they focus on the individual's history, include a thorough physical examination, and provide recommendations based on findings, although geared toward general health rather than athletic participation.

  • Military Enlistment Physical Examination Forms: Required for individuals seeking to join the armed forces, these forms evaluate one's physical and medical fitness for military service. Both this and the Alabama High School Physical Form require a detailed medical history, a physical exam, and ultimately, a healthcare provider's judgment on the individual's fitness for the intended role.

  • Driver’s License Health Assessment Forms: Some states require a health assessment to ensure a driver's medical fitness. These assessments, while generally less comprehensive, share important similarities with the high school physical form, including checks on specific health concerns that could impact the safe operation of a vehicle, mirroring the concern for safety in athletic participation.

  • Immunization Records: Although primarily documenting vaccination history rather than providing a comprehensive health assessment, immunization records are often required alongside the physical form for school athletics. This ensures that participants are not only physically ready but also immunologically protected against certain diseases, similar to how the physical form assesses readiness and safety for participation in sports.

Dos and Don'ts

When completing the Alabama High School Physical form, it is important to follow specific do's and don'ts to ensure accuracy and compliance with the Alabama High School Athletic Association (AHSAA) requirements. Here are the guidelines:

Do:
  • Provide honest and thorough answers to all questions. If you answer "Yes" to any questions, make sure to explain as required by the form.
  • Ensure that both the athlete and a parent or guardian sign the form. These signatures are necessary for the form’s validity.
  • Consult a physician (M.D. or D.O.) for the physical examination. The form must be completed by a licensed physician to be accepted.
  • Keep a copy for your records. After submitting the original form to the school or relevant athletic office, it’s wise to have a copy in case the form is misplaced or additional verification is needed.
Don't:
  • Leave sections incomplete. If a section does not apply, indicate this with an "N/A" (not applicable) rather than leaving it blank to avoid any assumptions of oversight.
  • Rely on outdated medical information. The physical examination must reflect the student’s current health status and is valid for one calendar year from the date of the exam.
  • Alter the form after it has been completed by the physician. Any changes or additions must be clearly communicated and sanctioned by the examining physician, with appropriate documentation.
  • Forget to review the final clearance status indicated by the physician at the bottom of the form. It’s crucial to understand any restrictions or recommendations made by the physician regarding the student’s participation in athletics.

Misconceptions

There are several misconceptions about the Alabama High School Athletic Association (AHSAA) Preparticipation Physical Evaluation Form, commonly known as the Alabama High School Physical form. Understanding these clarifications can ensure that students, parents, and educators correctly navigate the process of athletic participation.

  • It’s only for high school students: While it's often called the Alabama High School Physical form, it's actually required for students in grades 7-12 who wish to participate in interscholastic athletics, not just high school students.

  • Any physical form will work: The AHSAA requires the use of their specific Physicians Certificate (Form 5). Using a different form, even if it was completed by a doctor, does not meet their requirements.

  • Physicals are good for the school year: A physical exam is valid for one calendar year from the date of the exam. This means a student-athlete may need a new physical during a school year if their last examination was conducted more than a year ago.

  • Doctors can only recommend non-participation: The examining physician has three clearance options: fully cleared, cleared after completing evaluation/rehabilitation, or not cleared for participation in certain types of sports (e.g., collision, contact, noncontact). This means doctors have a range of recommendations based on their assessment.

  • Any doctor can sign the form: The form must be signed by a licensed physician, which includes MDs (Doctor of Medicine) or DOs (Doctor of Osteopathic Medicine). This criteria ensures that a qualified medical professional assesses the athlete's physical condition.

  • All sections of the history must be completed by the physician: The history section of the form is to be filled out by the student and parent/guardian prior to the examination. The physician reviews this section but focuses on the physical examination portion.

  • The form is only for assessing general fitness: While general fitness is a significant part of the form, it also includes sections for medical history, including questions about ongoing medical conditions, allergies, and previous injuries or surgeries, to ensure comprehensive understanding of the student's health.

  • Privacy concerns prevent thorough checking: Although privacy is always a priority, the form includes a comprehensive list of health issues to be checked and discussed openly between the athlete, their guardians, and the examining doctor. This thorough approach ensures student athletes are safely cleared for participation.

  • A digital signature is sufficient for submission: The current process requires a physical signature from both the athlete and the parent/guardian on the form. This ensures accountability and verifies that both parties understand and agree to the health information shared on the form.

Addressing these misconceptions helps streamline the process for students wishing to participate in interscholastic athletics, ensuring their safety and compliance with AHSAA regulations.

Key takeaways

Understanding the Alabama High School Physical Form is crucial for students, parents, and coaches involved in high school athletics. Here are key takeaways concerning this essential document.

  • Every student athlete needs a completed form on file to participate in sports. It serves as a confirmation that the student is medically fit for athletic activities.
  • The form captures detailed medical history, including past injuries, hospitalizations, allergies, and any existing conditions. Accurate and honest answers are vital for the safety of the student.
  • A physical examination section is included, to be completed by a licensed physician (M.D. or D.O.). This section assesses the student’s current physical health status across various parameters like cardiovascular health, musculoskeletal condition, and more.
  • The outcome of the physical examination determines the student's eligibility. It concludes with one of three clearances: fully cleared, cleared after specific conditions are met, or not cleared for participation. The reasons for any restrictions must be documented.
  • This physical evaluation is valid for one calendar year from the date of the exam. Students must ensure their form is up-to-date to continue their participation in athletics without interruption.
  • Both the student athlete and their parent or guardian are required to sign the form, certifying that the information provided is accurate to the best of their knowledge.

Proper completion and understanding of the Alabama High School Physical Form are imperative to ensure the health and safety of student athletes, helping to foster a positive and safe sports experience.

Please rate Free Alabama High School Physical PDF Template Form
5
Excellent
2 Votes