Blank Alabama High School Physical PDF Form

Blank Alabama High School Physical PDF Form

The Alabama High School Physical form is a crucial document that ensures student-athletes are medically fit to participate in sports. This form collects essential health information and requires a physician's evaluation to certify that a student can safely engage in athletic activities. To get started on your athletic journey, fill out the form by clicking the button below.

The Alabama High School Physical form is an essential document designed to ensure the health and safety of student-athletes participating in interscholastic sports. This form gathers crucial information about a student’s medical history, including any previous injuries, chronic conditions, and current medications. It begins with basic personal details such as the athlete's name, age, and school, followed by a comprehensive health questionnaire. This questionnaire prompts students to disclose any past medical issues, such as sprains, concussions, or allergies, which may affect their ability to compete safely. Additionally, the form requires a physical examination by a licensed physician, who will assess the athlete's overall fitness and determine their eligibility for participation in sports. This evaluation is not only a requirement for compliance with the Alabama High School Athletic Association (AHSAA) regulations but also serves as a proactive measure to identify any health concerns that could arise during physical activity. By completing this form, both athletes and parents contribute to a safer sporting environment, ensuring that young athletes are physically prepared and cleared for the demands of their chosen sports.

Document Sample

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.)

File Specifics

Fact Name Details
Governing Law The Alabama High School Athletic Association (AHSAA) governs the physical evaluation requirements under Rule 1, Section 14.
Eligibility Requirement Students in grades 7-12 must have a current physician's statement on file to participate in interscholastic athletics.
Form Usage The AHSAA Physicians Certificate (Form 5) must be used for the physical evaluation.
Validity Period A physical exam is valid for one calendar year from the date of the exam.
Information Collected The form collects personal information such as name, age, address, and medical history.
Medical History Students must disclose any past injuries, surgeries, or medical conditions that could affect participation.
Signature Requirement The form requires signatures from both the athlete and a parent or guardian for validation.
Physical Examination Components The evaluation includes assessments of cardiovascular health, musculoskeletal condition, and overall fitness.

How to Use Alabama High School Physical

Completing the Alabama High School Physical form is essential for student-athletes. This process ensures that all necessary health information is accurately documented, allowing for safe participation in sports. Follow the steps below to fill out the form correctly.

  1. Gather necessary information: Before starting, collect personal details such as the athlete's name, age, address, school, and grade.
  2. Complete the history section: Answer all questions regarding past medical issues, injuries, and conditions. Be honest about any "Yes" answers and provide explanations as needed.
  3. Fill in the date of birth: Clearly write the athlete's date of birth in the designated area.
  4. Provide contact information: Include a phone number for the athlete or their guardian.
  5. Select the sport: Indicate the sport or sports the athlete plans to participate in.
  6. Sign the form: Both the athlete and a parent or guardian must sign and date the form to confirm that the information is accurate.
  7. Complete the physical examination section: Have a physician perform a physical exam and fill out their findings, including clearance status.
  8. Physician's signature: Ensure the physician signs and dates the form, indicating their medical qualifications (M.D. or D.O.).

Your Questions, Answered

  1. What is the purpose of the Alabama High School Physical form?

    The Alabama High School Physical form is designed to ensure that student-athletes are healthy enough to participate in sports. It collects important medical history and requires a physical examination by a licensed physician. This helps identify any health issues that may affect a student's ability to play safely.

  2. Who needs to fill out the physical form?

    All students in grades 7 through 12 who wish to participate in interscholastic athletics must complete the physical form. This includes students involved in any sports offered by their school, whether it’s football, basketball, soccer, or any other athletic activity.

  3. How often do students need to submit a new physical form?

    A new physical form must be submitted every year. The physical exam is valid for one calendar year from the date it was performed. Therefore, students should plan to have their physicals done annually to maintain eligibility for sports participation.

  4. What information is required on the physical form?

    The form requires basic information such as the student's name, age, address, school, and grade. It also asks about the student’s medical history, including any past injuries, surgeries, or health conditions. A physician must complete the physical examination section, providing their assessment and clearance status.

  5. What happens if a student is not cleared to participate?

    If a student is not cleared to participate, the physician will specify the reasons on the form. They may recommend further evaluation, rehabilitation, or indicate specific types of activities the student should avoid. It’s important for students and parents to follow up on these recommendations to ensure the student’s health and safety.

  6. Where should the completed physical form be submitted?

    The completed physical form should be submitted to the school’s Superintendent or Principal’s office. It is essential for the form to be on file before the student can participate in any athletic activities. Schools may have specific deadlines for submission, so it’s wise to check with the school’s athletic department.

Common mistakes

  1. Failing to provide complete personal information such as name, age, and address can lead to delays in processing the form.

  2. Not checking all relevant medical history questions can result in important health issues being overlooked.

  3. Leaving out the signature of the athlete or parent/guardian renders the form invalid.

  4. Providing inaccurate or incomplete answers to questions about past injuries or medical conditions can affect eligibility.

  5. Not updating the form if there have been recent medical changes since the last physical exam can be a serious oversight.

  6. Neglecting to include the date of the physical examination can cause confusion about the validity of the form.

  7. Forgetting to indicate the sport the athlete will participate in may lead to complications during the approval process.

  8. Not providing a physician's signature or using an unqualified individual can invalidate the physical evaluation.

  9. Failing to submit the form to the correct school office can delay participation in sports.

  10. Ignoring the clearance section of the form can lead to misunderstandings about the athlete's ability to participate.

Documents used along the form

The Alabama High School Physical form is essential for student-athletes, ensuring they are healthy enough to participate in sports. However, several other forms and documents are often required alongside this physical evaluation. Below is a list of these documents, each serving a specific purpose in the athletic eligibility process.

  • Medical History Form: This document gathers detailed information about the athlete's past medical conditions, surgeries, and any ongoing health issues. It helps the physician assess the athlete's overall health.
  • Parental Consent Form: Parents or guardians must sign this form to give their permission for the student to participate in sports. It typically includes acknowledgment of the risks involved in athletic activities.
  • Emergency Contact Form: This form provides contact information for someone who can be reached in case of an emergency during practices or games. It ensures quick communication if an athlete is injured.
  • Insurance Information Form: Athletes must provide details about their health insurance coverage. This information is crucial for medical treatment and any potential injuries that may occur.
  • Concussion Awareness Form: This document educates athletes and parents about the signs and symptoms of concussions. It often requires signatures to confirm understanding of the risks.
  • Drug Testing Consent Form: Some schools require athletes to consent to random drug testing. This form outlines the policies regarding drug use and the testing process.
  • Sports Participation Agreement: Athletes may need to sign an agreement outlining the expectations and responsibilities of participating in sports, including conduct and commitment.
  • Physical Activity Readiness Questionnaire (PAR-Q): This questionnaire helps determine if an athlete is ready to engage in physical activity. It assesses any health concerns that may need to be addressed.
  • Team Roster Form: Coaches often compile a roster that includes all athletes participating in a sport. This form helps with organization and communication within the team.

Each of these documents plays a vital role in ensuring the safety and well-being of student-athletes. By completing them thoroughly, athletes, parents, and schools can work together to create a safe and supportive sports environment.

Similar forms

The Preparticipation Physical Evaluation (PPE) form is similar to the NCAA Sports Physical Form. Both documents require a comprehensive medical history and a physical examination to assess a student-athlete's readiness for participation in sports. The NCAA form focuses on ensuring that athletes are free from medical conditions that could pose risks during competition. Additionally, both forms require signatures from a physician and a parent or guardian, emphasizing the importance of parental involvement in the health and safety of young athletes.

The AHA (American Heart Association) Health History Questionnaire bears similarities to the Alabama High School Physical form. Both documents aim to gather detailed health information from the athlete. The AHA questionnaire specifically focuses on cardiovascular health, asking about family history and personal risk factors. This information is crucial for ensuring that athletes do not have underlying heart conditions that could lead to serious health issues during physical activity.

The National Federation of State High School Associations (NFHS) Sports Physical Form is another comparable document. Like the Alabama form, the NFHS form requires athletes to provide a detailed medical history and undergo a physical examination. Both forms also include sections for documenting any previous injuries or health issues, ensuring that the examining physician has a comprehensive understanding of the athlete's health status before participation.

The US Soccer Federation Medical Release Form shares similarities with the Alabama High School Physical form as well. Both documents require a thorough medical evaluation and emphasize the need for a physician's approval before an athlete can participate in sports. The US Soccer form also includes specific questions about prior injuries and medical conditions, mirroring the Alabama form's approach to assessing an athlete's readiness to play.

The American Academy of Pediatrics (AAP) Sports Physical Form is another document that aligns with the Alabama High School Physical form. Both forms focus on the health and safety of young athletes by requiring a detailed medical history and a physical exam. The AAP form includes recommendations for age-appropriate physical activities and sports participation, similar to the guidance provided in the Alabama form regarding an athlete's ability to engage in various sports.

The Camp Health History Form is also similar in nature to the Alabama High School Physical form. Both documents collect information about an individual’s medical history, including allergies, medications, and previous injuries. This information is essential for ensuring the safety of participants in both athletic and camp environments, as it helps caregivers and medical personnel prepare for any potential health issues that may arise during activities.

Finally, the College Health Services Physical Examination Form mirrors the Alabama High School Physical form in its intent and structure. Both forms require a comprehensive medical history and a physical examination to determine an athlete's fitness for sports participation. The College Health Services form may also include additional sections on mental health and wellness, reflecting a growing awareness of the importance of overall health in sports participation, similar to the holistic approach taken in the Alabama form.

Dos and Don'ts

When filling out the Alabama High School Physical form, it is essential to follow specific guidelines to ensure the process is completed correctly. Below is a list of things you should and shouldn't do.

  • Do provide accurate personal information, including your name, age, and school.
  • Do answer all medical history questions truthfully, especially regarding past injuries and conditions.
  • Do ensure that a licensed physician completes the physical examination section of the form.
  • Do keep a copy of the completed form for your records.
  • Don't leave any sections blank; all questions must be answered.
  • Don't provide misleading or incorrect information about your health history.
  • Don't forget to obtain the necessary signatures from both the athlete and the parent or guardian.
  • Don't submit an outdated physical examination; it must be current within the last year.

Misconceptions

  • Misconception 1: The physical form is optional for all students.
  • In reality, the physical form is mandatory for students participating in interscholastic athletics in Alabama. A current physician's statement must be on file.

  • Misconception 2: Any doctor can complete the physical evaluation.
  • The evaluation must be performed by a licensed physician (M.D. or D.O.). This ensures that the examination meets the required standards.

  • Misconception 3: A physical exam is valid indefinitely.
  • A physical exam is only valid for one calendar year from the date of the exam. Students must get a new exam each year to remain eligible.

  • Misconception 4: Parents do not need to sign the form.
  • Both the athlete and a parent or guardian must sign the form. This confirms that the information provided is accurate and complete.

  • Misconception 5: The form can be filled out after the sports season begins.
  • The form must be completed and submitted before the start of the sports season. Late submissions can lead to ineligibility.

  • Misconception 6: Students can participate in sports without a completed form.
  • No student may participate in any athletic activities without a completed physical form on file. This is to ensure their health and safety.

  • Misconception 7: The physical examination only checks for injuries.
  • The examination assesses overall health, including cardiovascular fitness, musculoskeletal health, and other medical conditions that may affect participation.

  • Misconception 8: The form is the same for all sports.
  • While the general requirements are similar, specific sports may have additional requirements or recommendations that must be followed.

Key takeaways

When filling out the Alabama High School Physical form, consider the following key points:

  • Accuracy is crucial. Ensure all answers regarding medical history and current health status are truthful and complete.
  • Signature requirements. Both the athlete and a parent or guardian must sign the form, confirming the information provided is correct.
  • Timeliness matters. A physical exam is valid for one calendar year. Schedule your exam accordingly to maintain eligibility.
  • Consult with a physician. A licensed physician (M.D. or D.O.) must conduct the physical examination and provide a clearance statement.