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The Alabama High School Athletic Association requires all student-athletes to complete a Preparticipation Physical Evaluation Form before they engage in any interscholastic athletic activities. This comprehensive form is designed to ensure students are medically and physically fit to participate in sports, thereby minimizing the risk of sports-related injuries. It covers a wide array of health aspects, including a detailed medical history and a full physical examination. The medical history section asks for information regarding any past injuries, hospitalizations, allergies, and ongoing medical conditions, among other things. Students and their parents must answer questions truthfully, acknowledging conditions like asthma, diabetes, or any history of concussions that could affect sports participation. Additionally, the physical examination component assesses the student's musculoskeletal, cardiovascular, and overall health status, ensuring they're up to the challenges of high school sports. This form, which must be signed by a certified physician, stands as a key document in safeguarding the well-being of young athletes. Moreover, it meets the AHSAA's requirements by providing a physician's clearance which is valid for one calendar year, confirming a student's eligibility for interscholastic sports from grades 7 to 12. The process epitomizes the necessary precautions taken to prioritize student health and safety in the realm of high school athletics in Alabama.

Alabama High School Physical Example

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.)

▼ PDF File

Form Specs

Fact Detail
Form Title Alabama High School Athletic Association Preparticipation Physical Evaluation Form
Content Included History, Physical Examination, Certification of Physical Fitness
Purpose To ensure the athlete is physically able to participate in interscholastic athletics
Eligibility Age Grades 7-12
Validity Period One calendar year from the date of the exam
Governing Law AHSAA (Alabama High School Athletic Association) N.T. Rule 1, Sec. 14
Physician Qualifications Must be conducted by an M.D. (Doctor of Medicine) or D.O. (Doctor of Osteopathic Medicine)

Detailed Guide for Writing Alabama High School Physical

Filling out the Alabama High School Physical form is an important step for high school athletes wishing to participate in sports. This form ensures the athlete's health and safety by documenting their medical history and physical examination results. To complete the form accurately, gather all necessary health information beforehand and follow these steps:

  1. Start with the section titled "History." Enter the athlete's name, sex, age, address, school, and grade.
  2. In the spaces provided, insert the athlete’s date of birth and phone number. Specify the sport(s) the athlete intends to participate in by writing it/them next to "Sport".
  3. Respond to the series of health questions. Mark "Yes" or "No" for each question. For any "Yes" answers, explain the details in the space given below the question. The questions cover a wide range of health topics, including allergies, previous injuries, and any ongoing medical conditions.
  4. For the section that asks about history of surgeries or menstrual periods, provide detailed explanations if you answered “Yes.”
  5. At the bottom of the first page, the athlete and their parent or guardian must sign and date, confirming that the information provided is accurate to the best of their knowledge.
  6. Proceed to the "Physical Examination" section. This portion is to be completed by a physician. It includes checks for height, weight, blood pressure, pulse, vision, and a series of other physical health indicators.
  7. In the Physical Examination section, the physician will mark results as "Normal," "Abnormal," "Corrected," or "Not Corrected" and note specific findings.
  8. Under "Findings Clearance," the physician will indicate the athlete's eligibility status for participation: A) Cleared, B) Cleared after completing evaluation/rehabilitation for specific conditions, or C) Not cleared for certain types of activities due to specific health concerns.
  9. The physician must provide their recommendation, name, address, phone number, and signature at the bottom of this section, along with the date of the exam.

Once all sections of the form are filled out and signed appropriately, submit it to the specified school authority to complete the process. Remember that the physical exam validity lasts one calendar year from the date of examination, so take note of when a new examination might be necessary to maintain eligibility.

Common Questions

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

The Alabama High School Physical form is designed to ensure that students are medically and physically capable of participating in interscholic athletic activities. It helps to identify any potential health risks that could be exacerbated by physical exertion and ensures the safety of the student during their athletic participation.

Who needs to complete the Alabama High School Physical form?

Any student wishing to partake in interscholastic athletics in grades 7 through 12 within the state of Alabama must complete this form. This includes students participating in any sports or physical activities recognized by their school's athletic department.

What information is required on this form?

The form requires a comprehensive history that includes the student’s name, sex, age, address, school, grade, and detailed medical history. This includes any past or present medical conditions, allergies, medications taken, and any previous injuries or hospitalizations. A physical examination section must also be filled out by a licensed physician, detailing the student’s current physical health status.

How often does the physical need to be completed?

The physical exam must be completed annually. The Alabama High School Athletic Association mandates that the physical examination's clearance is valid for one calendar-year from the date of the exam.

Can any doctor complete the physical examination?

Yes, the examination can be performed by any licensed physician, but they must be an M.D. (Doctor of Medicine) or a D.O. (Doctor of Osteopathy). The examining physician must certify that, in their opinion, the student is fully able to participate in interscholastic athletics.

What happens if a student is not cleared for participation?

If a student is not cleared for participation, the physician will indicate whether this is due to physical limitations that preclude participation in collision, contact, non-contact, strenuous, moderately strenuous, or nonstrenuous sports. Recommendations for evaluation, rehabilitation, or restrictions will also be documented. The student must follow these recommendations before they can be cleared for athletic activities.

Are students with ongoing medical conditions able to participate in sports?

Students with ongoing medical conditions can participate as long as their condition is under control and they are cleared by a physician. It is imperative that any health issues are fully disclosed and managed according to the physician’s recommendations. Adjustments or accommodations might be made based on the physician's advice.

Who is responsible for submitting the completed form?

Once completed and signed by both the examining physician and the parent/guardian, it is typically the student's responsibility to submit the form to their school's athletic department or administration office. However, it's recommended to double-check with the school for specific submission guidelines.

Is there a difference between the physical form for middle school and high school athletes?

The Alabama High School Athletic Association (AHSAA) Preparticipation Physical Evaluation Form is used across both middle and high schools, covering grades 7-12. There is no separate form for middle school athletes; all students in grades 7 through 12 use the same form for athletic physical assessments.

Common mistakes

When it comes to filling out the Alabama High School Physical form, a number of common mistakes can lead to delays or even the inability to participate in high school athletics. Recognizing and avoiding these errors is critical for a smooth approval process.

One widely seen mistake is incomplete answers to the health history questions. These questions are designed to ensure the safety of the student-athlete, and skipping any can raise concerns. For example, not specifying if the student has ever had issues with asthma or allergies can be problematic.

Another error is failing to explain "Yes" answers

. Simply checking 'Yes' to a question without providing details leaves the medical examiner without enough information. If a student has had a surgery, for example, it's crucial to describe what kind of surgery and any ongoing implications it might have on their physical activity.

Participants often forget to date and sign the form. Both the student and a parent or guardian need to sign and date the form, affirming that the information provided is accurate to the best of their knowledge. Missing signatures can invalidate the entire form.

Not providing clearance information from the physician properly is another common error. The form requires a physician's statement regarding the student's ability to participate in sports. This includes marking the student as cleared, cleared after further evaluation, or not cleared for certain types of sports. Incorrectly marking this section or leaving it blank can cause unnecessary confusion.

Overlooking the need for an up-to-date physical examination occurs frequently. The physical exam must be current, within one calendar year of the participation date. Submitting an outdated form can result in the student being ineligible to participate in athletics.

Lastly, there's incorrect contact information. Providing wrong or incomplete contact details for either the student or the physician can lead to communication issues. Accurate contact information is essential for any follow-up questions or clarifications.

To summarize, here are the six mistakes to avoid:

  1. Leaving answers incomplete.
  2. Failing to explain "Yes" answers.
  3. Forgetting to date and sign the form.
  4. Not properly providing clearance information from the physician.
  5. Overlooking the need for an up-to-date physical examination.
  6. Providing incorrect contact information.

Making sure these areas are covered correctly can ensure a smoother process for everyone involved and help the student get onto the field as quickly as possible.

Documents used along the form

In the realm of high school athletics within Alabama, completing the Alabama High School Athletic Association Preparticipation Physical Evaluation Form is a pivotal step for students aspiring to participate in sports. However, this physical form is just one piece of a collection of documents necessary to fully assess and understand a student-athlete's health and readiness for sports participation. These additional forms work in tandem to provide a comprehensive outlook on the athlete's medical history, emergency information, consent, and more.

  1. Emergency Medical Authorization Form: This document is crucial as it collects contact information for parents or guardians and designates consent for medical treatment in case of an emergency when they cannot be reached.
  2. Concussion Information Form: This provides information on concussion awareness. Students and parents must acknowledge they understand the risks of concussions and the protocols for return to play following such an injury.
  3. Acknowledgement of Rules Form: It outlines the rules and expectations set forth by the school or athletic association, which the student-athlete agrees to follow. It ensures that athletes understand their responsibilities regarding conduct, practice, and competition.
  4. Insurance Verification Form: This form requires information about the student-athlete’s health insurance coverage, asserting that the student is covered under a health insurance plan.
  5. Drug Testing Consent Form: For schools that participate in drug testing of athletes, this form is necessary for the student-athlete and their parents or guardians to consent to random drug testing.
  6. Medical History Form: Although the Preparticipation Physical Evaluation includes a section for medical history, a more detailed medical history form may be requested to provide deeper insights into the student’s health background.
  7. Activity Consent Form: This form gathers written permission from a parent or guardian for the student to participate in athletics, outlining the risks associated with sports participation.
  8. Cardiac Arrest Information Form: Similar to the concussion form, this document educates and gathers acknowledgments from students and parents about the risks of sudden cardiac arrest during athletic activities.

Together, these documents create a thorough profile of the student-athlete, ensuring they are safe, informed, and legally protected to participate in athletic activities. It is in the best interest of students, parents, and schools to approach this documentation attentively, as each form contributes to the welfare and readiness of young athletes stepping onto the field or court.

Similar forms

The Alabama High School Physical form is similar to other health and safety compliance documents used in various contexts, notably in collegiate sports and employment physical examinations. Each of these documents, while tailored to their specific environments, shares a fundamental goal: evaluating an individual's physical capability and overall health to safely participate in a desired activity.

Collegiate Sports Physical Examination Forms
Similar to the Alabama High School Physical Form, collegiate sports physical examination forms are comprehensive assessments designed to determine athletes' fitness levels for college-level sports participation. These forms typically include a detailed medical history section, requiring athletes to disclose past injuries, surgeries, allergies, and any medication currently being taken. The examination section assesses vital signs, cardiovascular health, musculoskeletal integrity, and other physical conditions relevant to athletic performance. The primary similarity lies in the preventive approach both forms take, aiming to identify health issues that could jeopardize the athlete's safety during competition.

Employment Physical Examination Forms
Employment physical examination forms serve a similar purpose in the workplace, especially for roles that demand physical labor or specific fitness levels. These forms also start with a comprehensive review of the individual’s medical history, including questions about past surgeries, chronic conditions, and medication use. The physical exam portion evaluates the individual's ability to perform job-related tasks, which may include strength testing, flexibility assessments, and cardiovascular fitness checks. The alignment with the Alabama High School Physical form is evident in their shared emphasis on ensuring individuals are physically capable of safely engaging in their respective activities, be it sports or occupational tasks.

Dos and Don'ts

When completing the Alabama High School Physical form, there are specific actions to take and avoid to ensure the process goes smoothly and accurately. This guidance is crucial for both students and their guardians to follow for a successful submission of the form.

Do's:

  • Ensure accuracy in all the provided details. Double-check the information such as name, date of birth, address, and responses to the health history questions. Accurate information is fundamental to a correct assessment of the student’s eligibility for participation in sports activities.
  • Discuss any "Yes" answers comprehensively. If any question in the History section is answered with a "Yes," provide a thorough explanation in the space provided or on an additional sheet if necessary. Detailed information helps school officials and healthcare providers understand the student's medical history and make informed decisions.
  • Sign the form as required. Both the student athlete and a parent or guardian must sign the form, attesting to the truthfulness and accuracy of the information. This is a crucial step for the validity of the form.
    • Considering the physical exam is valid for only one calendar year from the date of the examination, pay attention to the date to ensure that the form remains current throughout the sports season.

Don'ts:

  • Leave any sections blank. Every question and section on the form should be completed to provide a full medical history and current health status. Incomplete forms may not be accepted or may delay the student’s participation in athletic programs.
  • Forget to list any medications. It is essential to disclose all medications the student is currently taking, including over-the-counter drugs, prescriptions, and any supplements, as they can affect the student’s suitability for certain sports or physical activities.
  • Overlook the need for a physician’s signature. A healthcare provider (M.D. or D.O.) must examine the student, complete the Physical Examination section, and sign the form. Without this, the form is incomplete and will not meet the eligibility requirements for interscholastic athletics.
  • Ignore recommendations or required evaluations/rehabilitations. If the examining physician indicates any need for further evaluation, rehabilitation, or restrictions, it is crucial to follow these recommendations before the student participates in any athletic activities to ensure their safety and well-being.

Misconceptions

Understanding the Alabama High School Physical form is crucial for students, parents, and educators. However, there are several misconceptions that can cause confusion. Here are six common ones explained:

  • Only athletes need to complete the physical form. This is a misconception because the form is intended for all students participating in any interscholastic athletics, not just those in what are traditionally viewed as sports. Marching band members and others in physically demanding activities might also need to complete it.

  • The physical form is valid indefinitely. Actually, the physical exam is only valid for one calendar year from the date of the exam. Students must ensure their form is up-to-date to continue participating in activities.

  • A family doctor’s note can replace the form. This is incorrect. While a family doctor can complete the form, a note from them does not suffice. The specific Alabama High School Athletic Association's (AHSAA) Physicians Certificate (Form 5) must be used.

  • Students have to see an M.D. or D.O. for the physical. While the form should be signed by an M.D. or D.O., the AHSAA does not restrict who can perform the examination. However, having a licensed doctor complete the form may ensure all necessary checks are covered.

  • All sections of the form must be filled out for every student. The form is comprehensive to ensure student safety, but not all sections apply to every student. For instance, questions about menstrual periods are irrelevant to male students. The essential aspect is honest and complete answers to all applicable questions.

  • If a student is cleared for one sport, they are cleared for all sports. Clearance might vary by sport due to its specific physical demands. A student may be cleared to participate in one sport but not another, depending on the assessment of the examining physician.

It's important for students, parents, and school officials to understand these aspects of the Alabama High School Physical form to ensure all students are safely and effectively able to participate in their chosen activities.

Key takeaways

When preparing to participate in high school athletics in Alabama, students must complete the Alabama High School Athletic Association Preparticipation Physical Evaluation Form. Here are some key takeaways to ensure that the process goes smoothly:

  • Every athlete must have a completed form on file before they can participate in any sports activities. This requirement helps safeguard the health and safety of young athletes.
  • The form includes a detailed medical history section. Honesty in answering these questions is crucial, as it provides critical information about the athlete’s health to caregivers.
  • The physical examination must be performed by a licensed physician (M.D. or D.O.). This ensures that the evaluation meets the medical standards necessary for safe sporting participation.
  • Physical exams are valid for one calendar year from the date of the exam. Athletes need to plan for a new physical each year to maintain their eligibility to participate.
  • The physician will assess various health aspects, including musculoskeletal, cardiovascular, and general physical condition, to determine the athlete’s readiness for sports.
  • Based on the examination, the physician will mark the student as Cleared, Cleared after further evaluation/rehabilitation, or Not cleared for athletic participation. This decision guides what level of sports the athlete can safely engage in.
  • If an athlete is not cleared for participation due to a medical reason, it’s important to follow the physician’s recommendations for treatment or rehabilitation before attempting to participate.
  • Both the athlete and a parent or guardian must sign the form, certifying that the information provided is accurate to the best of their knowledge. This ensures that there is an agreement between the student, parent, and school regarding the athlete’s health condition and participation eligibility.

Completing the Alabama High School Athletic Association Preparticipation Physical Evaluation Form is a key step in ensuring the health and safety of high school athletes. It is a tool that helps identify if it's safe for students to participate in sports, and it supports the health of all students as they pursue their athletic goals. Remember, safety comes first, and this form is an essential part of that commitment.

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