The FHSAA EL 2 form is a crucial document required by the Florida High School Athletic Association for student-athletes to participate in sports. This form serves as a preparticipation physical evaluation, ensuring that students are medically cleared to engage in athletic activities. It must be filled out accurately and kept on file by the school for a period of one year.
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The FHSAA EL 2 form serves as a crucial document for student athletes in Florida, ensuring their health and safety before participating in sports. This preparticipation physical evaluation form is designed to collect essential information about the student’s medical history, current health status, and physical examination results. It must be completed annually and is valid for 365 days from the date of the evaluation. The form consists of several sections that require input from both the student and a licensed medical professional. In the first part, personal details such as the student's name, age, school, and sport are recorded. The second section focuses on medical history, where parents or guardians answer questions regarding any previous illnesses, injuries, or ongoing health issues that could impact the student’s ability to participate in sports. Finally, the third part of the form is completed by a physician or qualified healthcare provider, who conducts a physical examination and assesses the student’s readiness for athletic activities. Importantly, the form is non-transferable; should a student change schools during its validity, a new form must be submitted. This comprehensive approach not only promotes student safety but also fosters a culture of health awareness among young athletes.
EL2
Florida High School Athletic Association
Preparticipation Physical Evaluation (Page 1 of 3)
REVISED 03/16
This completed form must be kept on ile by the school. This form is valid for 365 calendar days from the date of the evaluation as written on page 2.
This form is non-transferable; a change of schools during the validity period of this form will require page 1 of this form to be re-submitted.
Part 1. Student Information (to be completed by student or parent)
Student’s Name: ________________________________________________________________________ Sex: _____ Age: _____ Date of Birth: _____/ _____/ _____
School: ____________________________________________________ Grade in School: _____ Sport(s): ________________________________________________
Home Address: _______________________________________________________________________________________ Home Phone: ( _____) _______________
Name of Parent/Guardian: _______________________________________________________________ E-mail: ___________________________________________
Person to Contact in Case of Emergency: _____________________________________________________________________________________________________
Relationship to Student: _______________________ Home Phone: ( _____) ______________ Work Phone: ( _____) _____________ Cell Phone: ( _____) _____________
Personal/Family Physician: ___________________________________________City/State: ___________________________ Ofice Phone: ( _____) _____________
Part 2. Medical History (to be completed by student or parent). Explain “yes” answers below. Circle questions you don’t know answers to.
Yes
No
1.
Have you had a medical illness or injury since your last
____
check up or sports physical?
2.
Do you have an ongoing chronic illness?
3.
Have you ever been hospitalized overnight?
4.
Have you ever had surgery?
5.
Are you currently taking any prescription or non-
prescription (over-the-counter) medications or pills or
using an inhaler?
6.
Have you ever taken any supplements or vitamins to
help you gain or lose weight or improve your
performance?
7.
Do you have any allergies (for example, pollen, latex,
medicine, food or stinging insects)?
8.
Have you ever had a rash or hives develop during or
after exercise?
9.
Have you ever passed out during or after exercise?
10.
Have you ever been dizzy during or after exercise?
11.
Have you ever had chest pain during or after exercise?
12.
Do you get tired more quickly than your friends do
during exercise?
13.
Have you ever had racing of your heart or skipped
heartbeats?
14.
Have you had high blood pressure or high cholesterol?
15.
Have you ever been told you have a heart murmur?
16.
Has any family member or relative died of heart
problems or sudden death before age 50?
17.
Have you had a severe viral infection (for example,
myocarditis or mononucleosis) within the last month?
18.
Has a physician ever denied or restricted your
participation in sports for any heart problems?
19.
Do you have any current skin problems (for example,
itching, rashes, acne, warts, fungus, blisters or pressure sores)?
20.
Have you ever had a head injury or concussion?
21.
Have you ever been knocked out, become unconscious
or lost your memory?
22.
Have you ever had a seizure?
23.
Do you have frequent or severe headaches?
24.
Have you ever had numbness or tingling in your arms,
hands, legs or feet?
25. Have you ever had a stinger, burner or pinched nerve?
26.
Have you ever become ill from exercising in the heat?
27.
Do you cough, wheeze or have trouble breathing during or after
activity?
28.
Do you have asthma?
29.
Do you have seasonal allergies that require medical treatment?
30.
Do you use any special protective or corrective equipment or
medical devices that aren’t usually used for your sport or position
(for example, knee brace, special neck roll, foot orthotics, shunt,
retainer on your teeth or hearing aid)?
31.
Have you had any problems with your eyes or vision?
32.
Do you wear glasses, contacts or protective eyewear?
33.
Have you ever had a sprain, strain or swelling after injury?
34.
Have you broken or fractured any bones or dislocated any joints?
35.
Have you had any other problems with pain or swelling in muscles,
tendons, bones or joints?
If yes, check appropriate blank and explain below:
___ Head
___ Elbow
___ Hip
___ Neck
___ Forearm
___ Thigh
___ Back
___ Wrist
___ Knee
___ Chest
___ Hand
___ Shin/Calf
___ Shoulder
___ Finger
___ Ankle
___ Upper Arm
___ Foot
36.
Do you want to weigh more or less than you do now?
37.
Do you lose weight regularly to meet weight requirements for your
sport?
38.
Do you feel stressed out?
39.
Have you ever been diagnosed with sickle cell anemia?
40.
Have you ever been diagnosed with having the sickle cell trait?
41.
Record the dates of your most recent immunizations (shots) for:
Tetanus: _______________
Measles: _______________
Hepatitus B: ____________
Chickenpox: ____________
FEMALES ONLY (optional)
42.When was your irst menstrual period? _______________________
43.When was your most recent menstrual period? _________________
44.How much time do you usually have from the start of one period to the start of another?_______________________________________
45.How many periods have you had in the last year? _______________
46.What was the longest time between periods in the last year? ________
Explain “Yes” answers here:_______________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________
We hereby state, to the best of our knowledge, that our answers to the above questions are complete and correct. In addition to the routine medical evaluation required by s.1006.20, Florida Statutes, and FHSAA Bylaw 9.7, we understand and acknowledge that we are hereby advised that the student should undergo a cardiovascular assessment, which may include such diagnostic tests as electrocardiogram (EKG), echocardiogram (ECG) and/or cardio stress test.
Signature of Student: _____________________________________ Date: ____/ ____/ ____ Signature of Parent/Guardian: __________________________________ Date: ____/ ____/ ____
– 1 –
Preparticipation Physical Evaluation (Page 2 of 3)
Part 3. Physical Examination (to be completed by licensed physician, licensed osteopathic physician, licensed chiropractic physi- cian, licensed physician assistant or certiied advanced registered nurse practitioner).
Student’s Name: _____________________________________________________________________________________________ Date of Birth: _____/_____/_____
Height: _____________ Weight: _____________ % Body Fat (optional): ____________ Pulse: _________ Blood Pressure: ____ / ____ ( ____/____ , ____ /____ )
Temperature: _____________ Hearing: right: P ______ F _____ left: P _____ F _____
Visual Acuity: Right 20/_______
Left 20/_______
Corrected: Yes
Pupils: Equal _________ Unequal _________
FINDINGS
NORMAL
ABNORMAL FINDINGS
INITIALS*
MEDICAL
Appearance
________
________________________________________________________________________
____________
Eyes/Ears/Nose/Throat
Lymph Nodes
Heart
Pulses
Lungs
Abdomen
Genitalia (males only)
Skin
MUSCULOSKELETAL
Neck
Back
Shoulder/Arm
Elbow/Forearm
Wrist/Hand
Hip/Thigh
Knee
Leg/Ankle
Foot
* – station-based examination only
ASSESSMENT OF EXAMINING PHYSICIAN/PHYSICIAN ASSISTANT/NURSE PRACTITIONER
I hereby certify that each examination listed above was performed by myself or an individual under my direct supervision with the following conclusion(s):
____ Cleared without limitation
____ Disability: _____________________________________________________ Diagnosis: ___________________________________________________________
_______________________________________________________________________________________________________________________________________
____ Precautions: ________________________________________________________________________________________________________________________
____ Not cleared for: __________________________________________________________________________ Reason: ___________________________________
____ Cleared after completing evaluation/rehabilitation for: ______________________________________________________________________________________
____ Referred to ______________________________________________________________________________ For: ______________________________________
Recommendations: _______________________________________________________________________________________________________________________
Name of Physician/Physician Assistant/Nurse Practitioner (print): __________________________________________________________ Date: _____/_____/_______
Address: _______________________________________________________________________________________________________________________________
Signature of Physician/Physician Assistant/Nurse Practitioner: ____________________________________________________________________________________
– 2 –
Preparticipation Physical Evaluation (Page 3 of 3)
Student’s Name: _____________________________________________________________________________________________
ASSESSMENT OF PHYSICIAN TO WHOM REFERRED (if applicable)
I hereby certify that the examination(s) for which referred was/were performed by myself or an individual under my direct supervision with the following conclusion(s):
Name of Physician (print): ___________________________________________________________________________________________ Date: ____/____/_______
Signature of Physician: ___________________________________________________________________________________________________________________
Based on recommendations developed by the American Academy of Family Physicians, American Academy of Pediatrics, American Medical Society for Sports Medicine, American Orthopae- dic Society for Sports Medicine and American Osteopathic Academy for Sports Medicine.
– 3 –
Completing the FHSAA EL 2 form is essential for student-athletes to ensure their health and readiness for sports participation. The form consists of three parts: student information, medical history, and a physical examination by a licensed medical professional. It is important to fill out each section accurately and completely to avoid any delays in eligibility for sports.
What is the FHSAA EL2 form?
The FHSAA EL2 form is a Preparticipation Physical Evaluation required by the Florida High School Athletic Association (FHSAA) for student-athletes. It is used to assess the medical readiness of students to participate in sports. The form must be completed annually and kept on file by the school.
Who needs to complete the FHSAA EL2 form?
Every student who intends to participate in interscholastic athletics in Florida must complete the FHSAA EL2 form. This includes students across all grades and sports. The form must be filled out by the student or their parent/guardian and a licensed medical professional.
How long is the FHSAA EL2 form valid?
The FHSAA EL2 form is valid for 365 calendar days from the date of the medical evaluation recorded on the form. After this period, a new evaluation must be conducted, and a new form must be submitted.
What happens if a student changes schools?
If a student changes schools during the validity period of the FHSAA EL2 form, page 1 of the form must be re-submitted to the new school. The form is non-transferable between schools.
What medical information is required on the form?
The form requires detailed medical history, including any past illnesses, injuries, surgeries, and current medications. It also includes a section for the physical examination conducted by a licensed medical professional, which assesses various aspects of the student's health.
Is there a specific medical professional who can complete the form?
The physical examination portion of the FHSAA EL2 form must be completed by a licensed physician, licensed osteopathic physician, licensed chiropractic physician, licensed physician assistant, or certified advanced registered nurse practitioner. This ensures that the evaluation is conducted by a qualified individual.
What if there are concerns regarding a student's health?
If there are any concerns regarding a student's health, the medical professional completing the form will note any disabilities, precautions, or recommendations. The student may be referred for further evaluation or rehabilitation if necessary. It is important for parents and guardians to discuss any health issues with the medical provider before completing the form.
Filling out the FHSAA EL2 form is an important step for student-athletes, but mistakes can lead to delays or complications. One common error is incomplete information. When students or parents skip sections or fail to provide all requested details, it can cause issues later on. Every field must be filled out accurately to ensure that the form is valid.
Another frequent mistake involves incorrect dates. Providing the wrong date of birth or the date of the last physical examination can create confusion. It is crucial to double-check these dates to avoid complications with eligibility.
Many individuals also overlook the medical history section. Failing to answer questions about past injuries or medical conditions can result in serious consequences. This section is essential for assessing the student’s fitness for participation in sports.
Additionally, some people forget to include the signature of a parent or guardian. Without this signature, the form may not be considered valid. It's essential to ensure that all required signatures are present before submitting the form.
Another common error is neglecting to update the form when transferring schools. If a student changes schools during the validity period, a new form must be submitted. This requirement is often overlooked, leading to potential eligibility issues.
Some also fail to provide contact information for the emergency contact. This is critical for the safety of the student-athlete. Ensure that all phone numbers are correct and that the contact person is readily available in case of an emergency.
Another mistake is not providing immunization dates. This information is necessary for compliance with school health regulations. Missing this data can delay the processing of the form.
Some individuals may not take the time to review the completed form for accuracy. A quick review can catch errors before submission. This step can save time and prevent unnecessary complications.
Lastly, many people do not understand the importance of consulting with a physician before filling out the medical history section. A thorough evaluation by a healthcare professional is essential for ensuring that all relevant health issues are addressed.
The FHSAA EL2 form is a critical document for student-athletes in Florida, ensuring that they undergo a thorough physical evaluation before participating in sports. However, several other forms and documents are often used in conjunction with the EL2 to provide a comprehensive view of a student-athlete's health and eligibility. Understanding these documents can help parents and students navigate the requirements more effectively.
In summary, the FHSAA EL2 form is just one part of a larger framework of documents that ensure student-athletes are physically and mentally prepared for sports participation. By understanding the purpose of each document, parents and students can better navigate the requirements and ensure a safe athletic experience.
The FHSAA EL 2 form is essential for student-athletes to participate in sports. It shares similarities with several other documents related to medical evaluations and health assessments. Here’s a list of nine documents that are similar to the FHSAA EL 2 form:
When filling out the FHSAA EL 2 form, it is essential to ensure accuracy and completeness. Below are nine important dos and don'ts to keep in mind.
Understanding the FHSAA EL2 form is crucial for student-athletes and their families. However, several misconceptions can lead to confusion. Here are nine common misunderstandings about this important document:
This form is required for all student-athletes, regardless of the type of sport they participate in. It ensures that every athlete is medically cleared to compete safely.
The form must be updated annually or whenever a student changes schools. It is valid for only 365 days from the date of the evaluation.
While parents play a significant role, students must also provide their information and medical history. This ensures accuracy and completeness.
In addition to the EL2 form, student-athletes may need to undergo other assessments, such as cardiovascular evaluations, depending on their medical history.
A licensed physician, physician assistant, or nurse practitioner must complete the physical examination section and provide their signature for the form to be valid.
The form is non-transferable. If a student changes schools, they must submit a new EL2 form to their new institution.
The form also includes questions about mental health, allergies, and chronic conditions, ensuring a comprehensive overview of the student’s health.
It is essential to complete the medical history section thoroughly, even if there are no known issues. This information helps medical professionals assess the student’s fitness for sports.
The form is applicable to middle school athletes as well, ensuring that all student-athletes are medically cleared to participate in sports.
Clarifying these misconceptions can help ensure that student-athletes are adequately prepared for their sports participation, promoting their health and safety.
Here are key takeaways regarding the FHSAA EL2 form, which is crucial for student-athletes participating in sports:
Ensure that all sections are filled out accurately to avoid delays in participation. The health and safety of student-athletes depend on thorough and honest disclosures in this form.