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When it comes to ensuring the safety and well-being of student-athletes in Alabama, the High School Physical form plays a critical role. This essential document is designed to gather comprehensive information about a student’s health history and current physical condition. It begins with basic details such as the athlete's name, age, school, and grade, setting the stage for a thorough evaluation. The form delves into past medical issues, asking about any previous injuries, surgeries, or chronic conditions that could impact athletic performance. This includes inquiries about musculoskeletal injuries, respiratory issues, and other relevant health concerns. Additionally, it requires signatures from both the athlete and a parent or guardian, affirming that the information provided is accurate. A physical examination by a licensed physician is also mandatory, ensuring that the student is cleared for participation in sports. This examination must be documented on the form, which remains valid for one year from the date of the exam. By prioritizing health and safety through this process, the Alabama High School Athletic Association helps safeguard the well-being of young athletes as they engage in competitive sports.

Dos and Don'ts

When filling out the Alabama High School Physical form, it is crucial to follow specific guidelines to ensure accuracy and compliance. Here are six important dos and don'ts to consider:

  • Do provide accurate personal information, including your name, age, and school.
  • Do answer all medical history questions truthfully, especially regarding past injuries or conditions.
  • Do have a parent or guardian review the form before submission to ensure all sections are completed.
  • Do sign and date the form where indicated, as this confirms the information provided is correct.
  • Don't leave any sections blank; incomplete forms can lead to delays in processing.
  • Don't use abbreviations or shorthand when filling out the medical history; clarity is essential.

By adhering to these guidelines, you can help facilitate a smoother process for your physical evaluation and ensure that all necessary information is accurately conveyed.

Document Attributes

Fact Name Description
Governing Body The Alabama High School Athletic Association (AHSAA) oversees the physical evaluation form.
Eligibility Requirement A current physician's statement must be on file for a student to participate in interscholastic athletics.
Physical Exam Validity The physical exam is valid for one calendar year from the date of the exam.
Form Usage The AHSAA Physicians Certificate (Form 5) is the required document for the physical evaluation.
Age Range This form is applicable for students in grades 7 through 12.
Medical History The form includes sections to report past medical issues, injuries, and ongoing conditions.
Signature Requirement Both the athlete and a parent or guardian must sign the form to validate it.
Physician's Role A licensed physician (M.D. or D.O.) must complete the evaluation and provide clearance.
Clearance Categories Clearance can be categorized as cleared, cleared after rehabilitation, or not cleared for specific activities.

Key takeaways

When filling out and using the Alabama High School Physical form, there are several important points to keep in mind:

  • Complete Information: Ensure all sections of the form are filled out accurately. This includes personal details such as name, age, and address.
  • Medical History: Be thorough when answering questions about past medical issues. This includes any previous injuries, surgeries, or ongoing health conditions.
  • Signature Requirement: Both the athlete and a parent or guardian must sign the form. This indicates that the information provided is correct to the best of their knowledge.
  • Physician's Examination: A licensed physician must conduct a physical examination. The results of this exam are crucial for determining the athlete's ability to participate in sports.
  • Validity Period: The physical examination is valid for one calendar year. After this period, a new evaluation will be necessary to maintain eligibility.
  • Clearance Status: The physician will indicate whether the athlete is cleared for participation, cleared after rehabilitation, or not cleared. This status is important for ensuring safety during sports activities.
  • Submission Location: The completed form must be submitted to the school’s Superintendent or Principal's office. This ensures that the athlete is officially recognized as eligible to participate in interscholastic athletics.

By following these guidelines, athletes can ensure they meet the necessary requirements for participation in sports while maintaining their health and safety.

Example - 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.)

Detailed Instructions for Writing Alabama High School Physical

Completing the Alabama High School Physical form is essential for student-athletes before participating in sports. This form collects personal information, medical history, and a physical examination report. Follow these steps to ensure the form is filled out correctly and thoroughly.

  1. Begin by entering the athlete's name, sex, and age at the top of the form.
  2. Fill in the address, school, and grade of the athlete.
  3. Answer the medical history questions. Indicate "Yes" or "No" for each condition listed, such as previous injuries, surgeries, or chronic illnesses.
  4. If "Yes" is selected for any question, provide detailed explanations in the space provided.
  5. Enter the date of birth and phone number of the athlete.
  6. Specify the sport the athlete will be participating in.
  7. Both the athlete and the parent or guardian must sign and date the form to confirm the accuracy of the information.
  8. Ensure that a physician conducts a physical examination and completes the evaluation section, including their findings and recommendations.
  9. The physician must sign and date the form, providing their contact information.
  10. Make copies of the completed form as needed for school records.

Documents used along the form

When preparing for participation in high school athletics in Alabama, it is essential to complete not only the Alabama High School Physical form but also several other documents. Each of these forms serves a specific purpose in ensuring the safety and well-being of student-athletes. Below is a list of commonly required forms that accompany the physical evaluation.

  • AHSAA Eligibility Form: This document confirms a student’s eligibility to participate in interscholastic athletics. It includes information about the athlete's academic standing and compliance with the rules set forth by the Alabama High School Athletic Association.
  • Concussion Awareness Form: This form educates athletes and their parents about the risks of concussions. It requires signatures to acknowledge understanding of the symptoms and the importance of reporting any head injuries.
  • Emergency Contact Form: This document provides essential contact information for parents or guardians. It is crucial for ensuring that the school can reach someone in case of an emergency during athletic events.
  • Insurance Verification Form: This form confirms that the student-athlete has adequate health insurance coverage. It protects both the athlete and the school in case of injuries sustained during practices or competitions.
  • Release of Liability Form: This form is essential for individuals participating in high-risk activities, providing legal protection by allowing them to relinquish the right to sue for any injuries sustained. For more details, click here to download the pdf.
  • Drug Testing Consent Form: Many schools require this form to obtain consent for random drug testing of athletes. It emphasizes the importance of maintaining a drug-free environment in sports.
  • Sports Participation Agreement: This document outlines the responsibilities and expectations of student-athletes. It often includes a code of conduct and the consequences of violating the rules.
  • Physical Therapy Referral Form: In cases where an athlete has previously been injured, this form may be necessary to facilitate any required physical therapy sessions prior to returning to play.
  • Health History Form: This form collects detailed medical history, including past injuries, surgeries, and chronic conditions. It assists healthcare providers in assessing the athlete's readiness for sports participation.
  • Parental Consent Form: This document requires a parent or guardian's signature, granting permission for the student to participate in athletics. It serves as a legal acknowledgment of the risks involved in sports.

Completing these forms is a vital step in ensuring that student-athletes are well-prepared for their sports activities. Each document plays a significant role in safeguarding the health and safety of young athletes while promoting a positive and responsible athletic environment.