Alabama High School Physical Template

Alabama High School Physical Template

The Alabama High School Physical Form is a vital document required for students who wish to participate in interscholastic athletics. This form collects essential health information and guarantees that a licensed physician has assessed the student’s fitness for sports participation. Ensuring that this form is filled out accurately and submitted on time is crucial for eligibility in the athletic programs.

Be sure to fill out the form by clicking the button below.

Content Overview

The Alabama High School Physical form serves as a crucial document for students aspiring to participate in interscholastic athletics. This comprehensive evaluation is not merely a formality; it is designed to ensure that young athletes are in optimal health before they engage in sports activities. Key components of the form include a personal history section where students must disclose pertinent medical information. This includes any previous injuries, surgeries, or health conditions that could impact their ability to safely participate in athletics. Additionally, the physical examination section requires the assessment of various physical attributes, such as height, weight, and cardiovascular health. A physician’s certification is vital, as it confirms that an athlete has passed the physical exam and is deemed fit for participation. Furthermore, the form delineates the different levels of clearance an athlete may receive, whether cleared for all types of sports or restricted to certain activities. Collectively, these elements emphasize the importance of safety, ensuring that every student can participate in sports with a full understanding of their health. Understanding each section of the form and providing accurate information is not only a requirement but also a commitment to the health and well-being of young athletes.

Alabama High School Physical 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.)

Document Attributes

Fact Name Description
Governing Body The Alabama High School Athletic Association (AHSAA) oversees the use of this physical form.
Eligibility Requirement To participate in interscholastic athletics, students in grades 7-12 must have a current physical on file.
Form Validity The physical examination is valid for one calendar year from the date it is performed.
Exam Certification A submitted physician’s statement must certify that the student is able to fully participate in athletics.
Required Signatures The form requires signatures from both the athlete and the parent or guardian to be valid.
Physical Examination Components The examination covers various health aspects, including cardiovascular, musculoskeletal, and vital signs.

Alabama High School Physical: Usage Instruction

Filling out the Alabama High School Physical form is an important step for athletes wishing to participate in sports. It ensures that students are in good health and ready for physical activity. You will need to provide detailed information regarding medical history and personal details. Follow the steps below to complete the form accurately.

  1. Gather necessary information: Collect personal details including your name, age, address, school, and grade.
  2. Answer medical history questions: Carefully go through each question. These may include past injuries, surgeries, or health issues.
  3. Provide details for "Yes" answers: If you answered "yes" to any question, be sure to explain the circumstances, including dates and the nature of the condition.
  4. Fill out personal identifiers: Include your date of birth and phone number where requested.
  5. Obtain signatures: Sign the form to confirm that your answers are accurate. A parent or guardian should also sign it.
  6. Schedule a physical exam: Arrange for a medical examination by a licensed physician (M.D. or D.O.).
  7. Physician completes exam: Your doctor will evaluate your overall health and fill out the required sections on the form.
  8. Submit the completed form: Once signed by both you and the physician, return the form to the appropriate school office.

Completing each step carefully will help ensure you are ready for your sports activities without any unexpected delays. Keep a copy of the completed form for your records, and remember that it is valid for one calendar year following the exam date.

Frequently Asked Questions

  1. What is the Alabama High School Physical form?

    The Alabama High School Physical form is a document that students must complete to participate in high school athletics. It serves to evaluate a student-athlete's physical fitness and medical history to ensure they are healthy enough to engage in sports activities. The form must include information about any past medical issues or current medications.

  2. Who needs to complete the form?

    Any student in grades 7 through 12 planning to participate in school-sponsored sports must fill out this form. This requirement ensures that all athletes meet the health standards necessary for their safety during physical activities.

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

    The physical exam documented on the form is valid for one calendar year from the date of the examination. Therefore, if a student wishes to participate in athletics for more than one year, they will need to have a new physical evaluation completed annually.

  4. What are the sections included in the physical form?

    The form consists of several sections designed to gather important medical history and physical evaluation data. Key areas include:

    • Personal details (name, age, address)
    • Medical history (any past injuries or conditions)
    • Physical examination findings by a physician
    • Clearance information (whether the student is cleared to participate in athletics)
  5. What happens if a student is not cleared for participation?

    If a student is not cleared for participation, it may be due to specific medical findings that require attention or rehabilitation. The physician will provide recommendations on what steps need to be taken for the student to become eligible for sports participation. It's essential for the student or their guardian to follow up with healthcare providers to address any issues reported during the examination.

Common mistakes

Completing the Alabama High School Physical form is essential for student-athletes, yet several common mistakes can easily lead to issues. One major error is failing to provide complete contact information. Many individuals neglect to fill in the phone number and address, which can create communication problems when the school needs to reach someone for urgent matters. Ensuring that all details, including your full name, age, and school, are correct is fundamental.

Another frequent mistake is not adequately addressing medical history questions. Often, athletes might misunderstand a question or overlook the importance of previous injuries. For example, a sprained ankle or past concussion should be fully explained, even if the individual thinks it is minor. Providing thorough responses helps physicians assess the athlete's readiness for sports safely.

Additionally, signatures can be a point of confusion. Both the athlete and parent or guardian are required to sign the form. Some may assume that only one signature suffices. This misunderstanding can delay the process and may even result in the student's ineligibility. It’s crucial to double-check that all necessary signatures are present before submitting the form.

Lastly, overlooking the expiration date of the physical exam can lead to unnecessary complications. The form requires a current physician's statement, stating that the student is eligible for participation. Many people forget this important detail. Regular consultation with a physician can ensure that the athlete always meets this requirement. Keeping track of the date of the exam and scheduling a new evaluation as needed is essential for uninterrupted eligibility in sports.

Documents used along the form

In accordance with the Alabama High School Athletic Association regulations, several forms and documents accompany the Alabama High School Physical form. These documents are integral to ensuring a comprehensive assessment of a student-athlete’s readiness for participation in sports. Below is a list of these additional forms, along with brief descriptions of each.

  • AHSAA Parent Permission Form: This document must be signed by a parent or guardian, granting permission for their child to participate in athletic activities. It typically outlines the risks associated with sports participation.
  • AHSAA Concussion Protocol Form: This form outlines the specific protocols for recognizing and managing concussions among student-athletes. It is crucial for ensuring that any signs of concussion are addressed promptly.
  • Emergency Contact Information Form: This document collects vital information regarding whom to contact in case of an emergency during practice or competition. It is essential for the health and safety of the student-athlete.
  • Physical Examination Report: A more detailed report from the physician that includes specific findings from the physical examination, which may elaborate on health issues pertinent to athletic participation.
  • Medical History Form: This form gathers comprehensive medical background information, allowing coaches and medical staff to be informed of any prior health issues that may affect the athlete.
  • Insurance Coverage Verification Form: This document confirms that the student-athlete has appropriate health insurance coverage in case of injury occurring during sports activities.
  • Participation Agreement: This form outlines the responsibilities and expectations of student-athletes, encouraging commitment and discipline in maintaining good standing within their sports team.
  • Medications Consent Form: A form that allows parents to authorize school staff to administer certain medications if required. This is particularly important for athletes who may need timely access to medications during practice or competitions.
  • Athletic Training Treatment Consent Form: This document provides consent for athletic trainers to administer necessary treatment and care for injuries sustained during practices or games.
  • Return to Play Protocol: Following any injury, this form outlines the necessary steps and medical clearances required for a student-athlete to safely resume participation in sports.

Each of these documents plays a vital role in the overall well-being and safety of student-athletes. Properly filling out and submitting these forms ensures that athletes are not only medically prepared but also supported by their families and schools as they engage in their athletic pursuits.

Similar forms

  • Sports Physical Examination Form: This document is similar as it evaluates an athlete's health before participating in sports. Both forms assess medical history and physical examinations to ensure safety during athletic activities.

  • Student Health History Form: Like the Alabama High School Physical form, this document collects important information about a student’s medical history to address any potential health issues before participation in sports.

  • National Federation of State High School Associations (NFHS) Physical Form: This form serves a similar purpose by ensuring students are physically fit and healthy enough to compete. It also requires a physician's approval for participation.

  • American Academy of Pediatrics Preparticipation Physical Evaluation: This document focuses on assessing the athlete's overall health and risks, mirroring the concerns outlined in the Alabama form.

  • State Waiver and Release Forms: These documents are often required alongside physical evaluations to protect organizations from liability. Both forms emphasize health and safety in sports participation.

  • Health Insurance Coverage Form: This document is related in that it ensures athletes have proper health coverage, in line with the physical evaluation's goal to promote safety and well-being in sports.

  • Emergency Contact and Medical Release Form: Similar to the physical form, this document identifies whom to contact in case of an injury and provides important medical information for treating the athlete.

Dos and Don'ts

When filling out the Alabama High School Physical form, it's essential to be thorough and accurate. Here are ten practical dos and don'ts to consider:

  • Do provide complete and honest answers about your medical history.
  • Do ensure all required sections of the form are filled out, including personal details like name, age, and sport.
  • Do have a parent or guardian review the form for accuracy before submission.
  • Do include accurate contact information for the parent or guardian.
  • Do sign and date the form where indicated.
  • Don’t omit any medical conditions or past injuries that could affect physical participation.
  • Don’t use jargon or abbreviations that might confuse the reviewing physician.
  • Don’t submit the form without having it signed by a licensed physician.
  • Don’t wait until the last minute to complete the form, especially as it needs verification by a physician.
  • Don’t forget to include any relevant details about medications or treatments currently in use.

Following these guidelines will help ensure a smooth process for participating in athletics.

Misconceptions

Misconceptions about the Alabama High School Physical form can impact both students and parents. Here are seven common misunderstandings:

  1. All students must receive a physical each year. This form is only required annually, ensuring that students are cleared to participate in interscholastic athletics for a full calendar year after the exam.
  2. The form guarantees full clearance for all sports. While passing the physical is necessary, the physician can still limit participation in certain activities depending on specific medical concerns or evaluations.
  3. Only a specific type of doctor can perform the examination. The form may be completed by a licensed physician, which includes M.D.s and D.O.s, allowing for flexibility in who can conduct the evaluation.
  4. Once a student turns 18, parental consent is no longer needed. Even at 18, students are still recommended to have a parent's signature on the form to ensure family oversight, though legal consent changes.
  5. The form only focuses on physical health. It also addresses mental health and past injuries, providing a comprehensive picture of a student's readiness to compete.
  6. All answers on the form must be “No” to be cleared. A student can have “Yes” answers, but these need to be discussed with the physician to ensure safety and appropriate management of health issues.
  7. Physicals are only for athletes involved in contact sports. Regardless of whether a sport is contact or noncontact, a physical is necessary to help prevent injuries and address health concerns for all participating students.

Understanding these misconceptions can help facilitate a smoother experience when obtaining and completing the physical form, ensuring student-athletes prioritize their health and well-being.

Key takeaways

Filling out the Alabama High School Physical form is an important step for student-athletes. Here are some key takeaways to keep in mind:

  • Ensure all sections are completed accurately, including personal information and medical history.
  • Be honest when answering questions about past injuries or medical conditions.
  • The form must be signed by both the student and a parent or guardian, indicating their awareness and consent.
  • A current physical examination by a licensed physician (M.D. or D.O.) is required for participation in interscholastic athletics.
  • The physical exam results are valid for one calendar year from the date of the examination.
  • Your physician will note any necessary recommendations regarding participation levels, including whether you are cleared or not cleared.
  • Retain a copy of the form for your records, in case it is needed for future reference.
  • Submit the completed form to the school's Superintendent or Principal to ensure eligibility for athletics.
  • If you have any questions or uncertainties, consult your doctor or the school’s athletic department for guidance.

More PDF Forms