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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 important information about the athlete’s medical history, including any previous injuries, surgeries, or ongoing health conditions. Parents or guardians are required to provide detailed answers regarding the athlete's past medical issues, such as asthma, diabetes, or any allergies. Additionally, the form includes a section for a physical examination conducted by a licensed physician, who must assess the athlete's overall fitness and ability to participate in sports. The physician’s evaluation is crucial, as it determines whether the student is cleared for participation, and it must be updated annually. The form also emphasizes the importance of understanding any restrictions or recommendations made by the physician, ensuring that the athlete’s well-being is prioritized. By completing this form, both parents and athletes contribute to a safer athletic environment, where informed decisions can be made regarding participation in sports activities.

Preview - Alabama High School Physical Form

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 Specifics

Fact Name Details
Governing Law The Alabama High School Athletic Association (AHSAA) Rule 1, Section 14 mandates that a current physician's statement must be on file for student-athletes.
Eligibility Requirement Students in grades 7-12 must pass a physical examination to be eligible for interscholastic athletics.
Form Validity The physical examination is valid for one calendar year from the date of the exam.
Physician's Certification AHSAA requires the use of the AHSAA Physicians Certificate (Form 5) for certifying a student's ability to participate.
Physical Examination Components The evaluation includes assessments of cardiovascular health, musculoskeletal conditions, and overall physical fitness.

Alabama High School Physical: Usage Instruction

Completing the Alabama High School Physical form is an essential step for students looking to participate in athletics. This process ensures that all necessary medical information is accurately recorded, allowing for safe participation in sports. Follow these steps to fill out the form correctly.

  1. Begin by filling in the athlete's Name, Sex, and Age at the top of the form.
  2. Provide the Address, School, and Grade of the athlete.
  3. Answer the medical history questions honestly. Indicate any past injuries, surgeries, or medical conditions by checking "Yes" or "No" as applicable.
  4. If you answer "Yes" to any questions, provide additional details in the space provided. Be specific about the nature of the injury or condition.
  5. Fill in the Date of Birth and Phone Number of the athlete.
  6. Select the Sport the athlete intends to participate in from the list provided.
  7. Sign the form to affirm that the information provided is accurate. The athlete should sign and date the form.
  8. Have a parent or guardian sign the form as well, indicating their consent and acknowledgment of the information.
  9. Ensure that the physician completes the physical examination section, including their findings and recommendations.
  10. Finally, make a copy of the completed form for your records, as it may be needed for future reference.

Learn More on Alabama High School Physical

  1. What is the Alabama High School Physical form?

    The Alabama High School Physical form is a document required for student-athletes in grades 7-12 to participate in interscholastic athletics. It includes a preparticipation physical evaluation to ensure the student is healthy enough for sports activities.

  2. Who needs to fill out the physical form?

    All students in grades 7-12 who wish to participate in sports must complete the physical form. This includes athletes in various sports, from football to swimming.

  3. What information is required on the form?

    The form requires personal information such as the athlete's name, age, address, school, and grade. It also asks about medical history, including any past injuries, surgeries, or medical conditions.

  4. How often do I need to submit the physical form?

    The physical exam is valid for one calendar year. You will need to submit a new form each year or if there are significant changes in the athlete's health.

  5. Where do I submit the completed form?

    The completed form must be submitted to the Superintendent's or Principal's office at the athlete's school. Make sure to keep a copy for your records.

  6. What happens if the athlete is not cleared to participate?

    If the physician does not clear the athlete, the form will indicate the reasons. The athlete may need to complete rehabilitation or follow specific recommendations before being eligible to participate.

  7. Can a parent or guardian sign the form?

    Yes, a parent or guardian must sign the form to acknowledge the information provided and give consent for the athlete to participate in sports.

  8. What if the athlete has a medical condition?

    If the athlete has a medical condition, it is important to disclose it on the form. The examining physician will assess the condition and determine if the athlete is fit to participate.

  9. Is there a specific physician that must conduct the exam?

    The physical exam must be conducted by a licensed physician (M.D. or D.O.). This ensures that the evaluation meets the requirements set by the Alabama High School Athletic Association.

  10. What should I do if I lose the physical form?

    If the physical form is lost, you can request a duplicate from your school. It’s a good idea to keep a few copies on hand to avoid any issues.

Common mistakes

Filling out the Alabama High School Physical form is a crucial step for student-athletes, but it's easy to make mistakes that could delay participation in sports. Here are seven common errors to avoid when completing this important document.

First, many people overlook the importance of providing accurate personal information. It may seem simple, but entering the wrong name, age, or address can lead to complications later. Always double-check this information to ensure it matches official documents.

Another frequent mistake is failing to disclose medical history accurately. If a student has had previous injuries or medical conditions, these should be clearly stated. Omitting this information can result in serious health risks during athletic participation. Be honest and thorough.

In addition, some individuals neglect to have a parent or guardian sign the form. This signature is not just a formality; it signifies that the parent is aware of the student's health status and consents to their participation in sports. Without this signature, the form may be considered incomplete.

Additionally, many forget to include the date of the physical examination. This date is vital as it determines the validity of the physical for one calendar year. Ensure that the physician's signature and the date are clearly marked to avoid any confusion.

Another common oversight is not following the instructions for the physical examination section. Each part of the evaluation must be completed accurately by the examining physician. If any section is left blank or marked incorrectly, it could lead to delays in eligibility.

Furthermore, some students fail to communicate with their physician about their athletic activities. It's essential for the doctor to understand the specific sports the student will be participating in, as this can affect their evaluation and recommendations.

Lastly, individuals often forget to keep a copy of the completed form. Having a duplicate is crucial for personal records and can be helpful if any questions arise later. Always make sure to have a copy on hand for reference.

By being mindful of these common mistakes, student-athletes can ensure a smoother process when submitting their physical forms. Taking the time to fill out the Alabama High School Physical form correctly can make all the difference in a young athlete's ability to participate in sports safely and effectively.

Documents used along the form

The Alabama High School Physical form is a critical document for student-athletes, ensuring they are medically cleared to participate in sports. In addition to this form, several other documents are commonly required to provide a comprehensive overview of a student's health and eligibility. Below is a list of these documents, each serving a specific purpose.

  • Medical History Form: This document collects detailed information about the athlete's past medical conditions, surgeries, allergies, and medications. It helps healthcare providers understand the athlete's health background and any potential risks.
  • Parental Consent Form: This form requires a parent or guardian's signature, granting permission for the student to participate in sports activities. It often includes acknowledgment of the risks involved in athletic participation.
  • Emergency Contact Information: This document lists individuals to contact in case of an emergency during practices or games. It ensures that the school has up-to-date contact information for parents or guardians.
  • Insurance Information Form: This form provides details about the athlete's health insurance coverage. It is essential for understanding how medical expenses related to sports injuries will be handled.
  • Concussion Awareness Form: This document educates athletes and their parents about the signs and symptoms of concussions. It often requires a signature to confirm that the athlete and their guardian understand the risks associated with head injuries.

These documents work together with the Alabama High School Physical form to ensure that student-athletes are prepared for participation in sports. Each form plays a vital role in safeguarding the health and well-being of the athletes while complying with school and athletic association requirements.

Similar forms

The Alabama High School Physical form shares similarities with the NCAA Pre-Participation Physical Evaluation (PPE) form. Both documents are designed to ensure that student-athletes are healthy enough to participate in sports. They require a thorough medical history and physical examination by a licensed physician. The NCAA form also emphasizes the importance of disclosing any previous injuries or medical conditions, mirroring the Alabama form's focus on past health issues. This common goal of safeguarding student-athletes' health is crucial in both settings.

Another document similar to the Alabama High School Physical form is the AHA (American Heart Association) Pre-Participation Physical Evaluation form. Like the Alabama form, the AHA version aims to assess the cardiovascular health of young athletes. It includes questions about family history of heart conditions and personal health issues, ensuring that athletes do not have underlying heart problems that could be exacerbated by physical activity. Both forms prioritize the well-being of student-athletes by requiring a comprehensive evaluation.

The MHSAA (Michigan High School Athletic Association) Health Questionnaire is another document that aligns closely with the Alabama High School Physical form. This questionnaire collects detailed health information from student-athletes, including medical history and current health status. It serves to identify any potential risks before participation in sports. Similar to the Alabama form, the MHSAA Health Questionnaire emphasizes the necessity of understanding an athlete's medical background to make informed decisions about their participation in athletics.

The CIF (California Interscholastic Federation) Physical Examination form also shares key features with the Alabama High School Physical form. Both documents require a physical examination by a healthcare provider and include sections for documenting the athlete's medical history. The CIF form, like its Alabama counterpart, aims to ensure that athletes are physically fit and free from medical conditions that could jeopardize their safety during sports activities.

The AIA (Arizona Interscholastic Association) Sports Physical form is another comparable document. It requires a detailed medical history and a physical examination, similar to the Alabama High School Physical form. The AIA form also includes a section for parental consent, emphasizing the collaborative role of parents in ensuring their child's health and safety in sports. Both forms are essential for maintaining the health standards of student-athletes.

The TSSAA (Tennessee Secondary School Athletic Association) Sports Physical form is another document that mirrors the Alabama High School Physical form. Both require athletes to provide information about their health history and undergo a physical exam. The TSSAA form includes a checklist of potential health issues, ensuring that all relevant information is reviewed by a physician. This thorough approach is vital for protecting the well-being of student-athletes in Tennessee, just as it is in Alabama.

The NFHS (National Federation of State High School Associations) Pre-Participation Physical Evaluation form also shares similarities with the Alabama High School Physical form. Both documents focus on assessing an athlete's readiness to participate in sports through a comprehensive medical history and physical examination. The NFHS form includes questions about previous injuries and medical conditions, reinforcing the importance of understanding an athlete's health background to mitigate risks during sports participation.

Lastly, the UIL (University Interscholastic League) Medical History form in Texas is akin to the Alabama High School Physical form. Both forms require student-athletes to disclose their medical history and undergo a physical examination. The UIL form emphasizes the importance of parental involvement, requiring signatures from guardians to confirm that they are aware of their child's health status. This shared focus on communication and thorough evaluation helps ensure that student-athletes are safe and healthy while participating in sports.

Dos and Don'ts

When filling out the Alabama High School Physical form, there are several important things to keep in mind. The following list includes actions to take and avoid to ensure the process goes smoothly.

  • Do read the entire form carefully before starting. Understanding what is required will help avoid mistakes.
  • Do provide accurate information regarding any medical history. This includes past injuries, surgeries, and current medications.
  • Do have a parent or guardian review the form if you are under 18. Their input can be crucial for accuracy.
  • Do sign and date the form where indicated. This confirms that the information is true to the best of your knowledge.
  • Don't leave any sections blank. Every question should be answered to the best of your ability.
  • Don't falsify any information. Providing incorrect details can have serious consequences for eligibility.
  • Don't forget to include the physician’s signature and contact information. This is essential for validation of the physical exam.

Misconceptions

Misconceptions about the Alabama High School Physical form can lead to confusion among students, parents, and coaches. Here are five common misunderstandings:

  • 1. A physical exam is only needed once in a student's high school career. Many believe that a single physical examination suffices for all four years of high school. In reality, the Alabama High School Athletic Association requires a new physical exam every year for students participating in interscholastic athletics.
  • 2. Any doctor can complete the physical form. Some assume that any healthcare provider can sign off on the physical form. However, only licensed physicians (M.D. or D.O.) are authorized to complete and sign the AHSAA Physicians Certificate.
  • 3. The form only assesses physical health. Many think the physical form focuses solely on physical fitness. In fact, it also includes questions about medical history, mental health, and any prior injuries that may affect participation in sports.
  • 4. Parents do not need to be involved in the process. Some parents believe their involvement is unnecessary. However, parental signatures are required on the form, indicating that they are aware of their child's health status and participation in athletics.
  • 5. The form is not important if the student feels healthy. A common misconception is that if a student feels fine, they do not need the form. This is misleading, as the physical examination can uncover hidden health issues that may not be apparent to the student or their parents.

Understanding these misconceptions is crucial for ensuring that student-athletes meet the necessary health requirements and are safe to participate in sports.

Key takeaways

Filling out the Alabama High School Physical form is an essential step for student-athletes. Here are some key takeaways to consider:

  • The form is required for students in grades 7-12 who wish to participate in interscholastic athletics.
  • It must be completed by a licensed physician, either an M.D. or a D.O.
  • Parents or guardians need to sign the form, confirming the accuracy of the information provided.
  • Students must disclose any medical history, including previous injuries and existing health conditions.
  • The physical examination is valid for one calendar year from the date it is conducted.
  • Clearance categories include “Cleared,” “Cleared after completing evaluation/rehabilitation,” and “Not cleared.”
  • Specific recommendations or restrictions may be noted by the physician based on the examination.
  • Students should keep a copy of the completed form for their records.
  • Ensure all sections are filled out completely to avoid delays in participation.
  • Submitting the form to the appropriate school office is crucial for eligibility in sports activities.

Following these guidelines will help ensure a smooth process for student-athletes and their families. Proper completion of the form contributes to the safety and well-being of young athletes participating in sports.