The Alabama High School Physical form is a critical document required for students participating in interscholastic athletics. This form ensures that each athlete undergoes a comprehensive medical evaluation, confirming their fitness to engage in sports activities. By collecting essential health information, the form aims to promote safety and well-being among student-athletes in Alabama.
The Alabama High School Physical form is a crucial document for students participating in interscholastic athletics. This form ensures that students are physically fit and healthy enough to engage in sports activities. It requires comprehensive information about the athlete's medical history, including any past injuries, surgeries, or ongoing medical conditions. Athletes must disclose any allergies, medications, or special medical needs that could impact their participation. The form also includes a physical examination section where a licensed physician evaluates the student’s overall health, focusing on cardiovascular, musculoskeletal, and other key systems. A physician's statement is necessary to confirm that the student has passed the physical exam and is cleared for participation. This clearance is valid for one calendar year, emphasizing the importance of regular health assessments for young athletes. Parents or guardians must also sign the form, ensuring that they are aware of their child's health status and the potential risks associated with athletic participation.
ALABAMA HIGH SCHOOL ATHLETIC ASSOCIATION
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
LIMITED
Normal
Abnormal Findings
Cardiovascular
Pulses
Heart
Lungs
Skin
E.N.T.
COMPLETE
Abdominal
Genitalia (males)
Musculoskeletal
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.)
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The Preparticipation Physical Evaluation (PPE) form is similar to the NCAA Sports Physical form. Both documents require athletes to undergo a physical examination before participating in sports. They gather comprehensive medical histories, including past injuries and current health issues. The NCAA form emphasizes the importance of ensuring that athletes are fit for competition, similar to the Alabama form, which also mandates a physician's clearance for participation in interscholastic athletics.
The AHA (American Heart Association) Screening Tool shares similarities with the Alabama High School Physical form, particularly in assessing cardiovascular health. Both documents include questions about heart conditions, family history of heart disease, and other risk factors. This information is crucial in determining whether a young athlete can safely engage in strenuous physical activity, reflecting a commitment to safeguarding student health.
The state-specific sports physical forms used in states like Texas or California also bear resemblance to the Alabama form. These documents require athletes to provide personal health information, including previous injuries and medical conditions. They serve the same purpose: ensuring that athletes are medically cleared to participate in their respective sports, thus promoting safety and well-being in school athletics.
The AAP (American Academy of Pediatrics) Health History form aligns with the Alabama form in its focus on comprehensive health assessments for children and adolescents. Both documents collect detailed health histories, including allergies, past surgeries, and chronic conditions. This information is vital for ensuring that young athletes can safely engage in physical activities, underscoring the importance of thorough medical evaluations.
The Sports Physical Exam form used by various youth sports leagues also resembles the Alabama High School Physical form. Like the Alabama form, it requires a medical evaluation and clearance from a physician. Both forms focus on assessing an athlete's fitness for participation, ensuring that any existing health issues are addressed before engaging in sports.
The School District Athletic Physical form is another comparable document. This form is often used by school districts to certify that student-athletes have undergone a medical evaluation. It shares similar sections, such as medical history and physical examination results, ensuring that the health and safety of students are prioritized before they participate in athletic activities.
The Military Entrance Processing Station (MEPS) physical examination form is akin to the Alabama High School Physical form in that it assesses an individual's fitness for rigorous physical activity. While the MEPS form is more comprehensive and includes evaluations for military service, both documents require a thorough medical history and a physical examination to ensure that individuals are fit for demanding physical challenges.
Lastly, the College Health Assessment form mirrors the Alabama High School Physical form in its focus on evaluating the health of incoming college students. Both forms require a comprehensive health history and a physical exam to ensure that students are prepared for the physical demands of college life, particularly for those participating in sports or other physically intensive activities.
Filling out the Alabama High School Physical form is essential for student-athletes. Here are some key takeaways to ensure the process is smooth and compliant:
The Alabama High School Physical form is a document required for students who wish to participate in interscholastic athletics. This form includes a preparticipation physical evaluation and a medical history questionnaire. It must be completed by a licensed physician to ensure that the student is fit for sports activities.
All students in grades 7-12 who plan to participate in any interscholastic sports must complete the Alabama High School Physical form. This includes students involved in team sports, individual sports, and any physical activities organized by the school.
The physical exam is valid for one calendar year from the date of the examination. Therefore, students must submit a new form each year to maintain eligibility for sports participation.
The form requires basic information such as the student’s name, age, address, school, and grade. Additionally, it includes a detailed medical history section that asks about past injuries, medical conditions, and any medications the student may be taking.
If a student is not cleared for participation, the physician will indicate the reasons on the form. This could be due to medical concerns or specific recommendations for rehabilitation. The student may need to follow up with their healthcare provider to address any issues before being cleared.
Once the form is completed and signed by both the athlete and their parent or guardian, it should be submitted to the Superintendent's or Principal's office at the student's school. This ensures that the school has a record of the student's physical examination and eligibility for sports.
Yes, the Alabama High School Physical form can be duplicated as needed. Schools often keep copies on file, but it’s advisable for parents and guardians to keep a copy for their records as well.