Preparticipation physical evaluation ohio high school athletic. The athlete does not have apparent clinical contraindications to practice and can participate in the sports as outlined on this form. A copy of the physical exam is on record in the cps athletic training office and can. A copy of the physical exam is on record in my office and can be made available to the school at the request of the parents. Ihave examined the abovenamed student and completed the preparticipation physical evaluation. Has the studentathlete been feeling down, depressed. This medical history form must be completed annually by parent or guardian and student in order for the student to participate in athletic activities. I have evaluated the above named student and completed the preparticipation physical evaluation.
Has the studentathlete had a medical problem or injury since their last evaluation. Ndhsaa preparticipation physical evaluation form starting with the 201011 school year, student athletes participating in ndhsaa sanctioned sports programs will be required to file a preparticipation health history screening and physical examination clearance form page 4 with their school office prior to their participation on a yearly basis. I understand that a copy of the ohsaa handbook is on file with the principal. These questions are designed to determine if the student has developed any condition which would make it hazato rdous participate in an event. This form is valid for 365 calendar days from the date of the evaluation as written on page 2. The athlete does not present apparent clinical contraindicationsto practice and participate inthe sports as outlined above. Head neck shoulder upper arm elbow forearm handfingers chest upper back lower back hip thigh kneecalfshinanklefoottoes. Preparticipation physical evaluation page 1 of 3 this completed form must be kept on file by the school. The form is designed to identify risk factors prior to athletic participation by way of a thorough medical history and physical examination.
Preparticipation physical evaluation medical history ll. Florida high school athletic association preparticipation physical evaluation page 3 of 3 this completed form must be kept on file by the school. Has the studentathlete had little interest or pleasure in doing things. I have examined the student named on this form and completed the preparticipation physical evaluation. A current sports physical is one performed on or after april 15 of the previous school year. To be completed by athlete or parent prior to examination. A copy of the physical exam is on record in my office and can be made available to the school at the request of the parent. Ppe preparticipation physical evaluation pdf in pdf to get started finding ppe preparticipation physical evaluation aap ppe preparticipation physical evaluation pdf database id 5, you are right to find our website which has a.
This physical examination form and procedures is intended for preparticipation athletic physicals. The athlete does not present apparent clinical contraindications to practice and participate in the sports as outlined above. Preparticipation physical evaluation history date of exam name sex age date of birth grade school sports address phone personal physician in case of emergency, contact name relationship phone h w explain yes answers below. Preparticipation physical evaluation physical examination form the physical examination must be performed on or after april 1 by a physician holding an unlimited license to practice medicine, a nurse practitioner or a physician assistant to be valid for the following school year. This form could be used for that purpose, as well, but it is important to note that there may be important components of the schoolentry physical examination. Preparticipation physical evaluation history date of examination name sexage date of birth grade school name sports address phone. C preparticipation physical evaluation medical history 2020 this medical history form must be completed annually by parent or guardian and student in order for the student to participate in activities.
This form is valid for 365 calendar days from the date. Preparticipation health examination form, updated november11, 2019. If so, how many and how long to recover from each one. Yes no circle questions you dont know the answers to.
Place a check beside each statement that applies to the studentathlete, elaborate in the space provided below. Document must be on file at the school before any participation in athletic. These questions are designed to determine if the student has developed any condition which would make it hazardous to participate in an athletic event. Archbishop mitty high school preparticipation physical health history address 2004 american academy of family physicians, american academy of pediatrics, american college of sports medicine, american medic i, the undersigned parent of the abovenamed student, a minor and student at archbishop mitty high school, hereby authorize any. Preparticipation physical evaluation medical history 2017 this medical history form must be completed annually by parent or guardian and student in order for the student to participate in activities. I have examined the abovenamed student and completed the preparticipation physical evaluation. Preparticipation physical evaluation pediatric associates. Revised 7105 mandatory preparticipation physical evaluation. Preparticipation physical evaluation physical examination. Preparticipation physical evaluation gahr high school. If conditions arise after the athlete has been cleared for participation. Do you feel stressed out or under a lot of pressure. To be completed and signed by the athlete and parentguardian if athlete is less than 18 years of age. C not medically eligible pending further evaluation c not medically eligible for any sports recommendations.
Piaa comprehensive initial preparticipation physical evaluation and certification of authorized medical examiner must be completed and signed by the authorized medical examiner ame performing the herein named students comprehensive initial preparticipation physical evaluation cippe and turned in to the principal, or the principals designee, of the students school. These questions are designed to determine if the student has developed any condition which would make it hazardous to participate in an event. Do you have any rashes, pressure sores, or other neurological 18. Preparticipation physical evaluation physical examination form name physician reminders 1. Preparticipation physical evaluation page 1 of 3 fhsaa. This completed form must be kept on file by the school. Personal physician in case of emergency, contact name relationship phone h phone w phone m explain yes answers below. Date of exam grade school date of birth sports name sex age. In the past, some schools have utilized the nsaa physical form for schoolentry physicals. Consider additional questions on more sensitive issues. Ihave examined the abovenamedstudent and completed the preparticipationphysical evaluation. I have examined the abovenamed student and student history and completed the preparticipation physical evaluation. The athlete does not present apparent contraindications to practice, tryout and participate in the sports as outlined above. Preparticipation physical evaluation physical examination form.
The physician should keep a copy of this form in the chart. Preparticipation physical evaluation clearance form. The ihsaa preparticipation physical evaluation ppe is the. Preparticipation physical evaluation medical history 2020 this medical history form must be completed annually by parent or guardian and student in order for the student to participate in activities. The physician should keep a copy of the form and give the athlete a copy. Students enrolled in grades 912 must have an annual preparticipation physical evaluation, dated april 1, 2020 or later for this school year, in order to participate in frederick county public schools fcps interscholastic and corollary athletics. This form is to be filled out by the patient and parent prior to seeing the physician. Preparticipation physical evaluation for athletics to parents or guardians. Archbishop mitty high school preparticipation physical health history address 2004 american academy of family physicians, american academy of pediatrics, american college of sports medicine, american medic.