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The Alabama High School Physical form plays a crucial role in ensuring the safety and well-being of student-athletes participating in interscholastic sports. This form requires detailed information about the athlete's medical history, including any past injuries, surgeries, or ongoing health issues that could impact their ability to participate in sports. The athlete's name, age, address, school, and grade must be clearly indicated, along with specific questions about previous medical conditions, allergies, and current medications. Additionally, the form includes a section for a physical examination conducted by a qualified physician, who must assess the athlete's overall health and fitness levels. The physician's evaluation includes checks on cardiovascular health, musculoskeletal strength, and other vital signs. A clear recommendation from the physician is essential, indicating whether the student is cleared for participation or if any restrictions apply. This comprehensive approach helps to ensure that all student-athletes are physically prepared and safe to engage in their chosen sports activities.

Document Specifics

Fact Name Fact Description
Governing Body The Alabama High School Athletic Association (AHSAA) oversees the physical evaluation process for high school athletes in Alabama.
Eligibility Requirement Students must have a current physician's statement on file to participate in interscholastic athletics, as mandated by AHSAA rules.
Form Usage The AHSAA Physicians Certificate (Form 5) is the official document required for the physical evaluation.
Age Range The physical evaluation applies to students in grades 7 through 12, ensuring that all middle and high school athletes are assessed.
Validity Period A physical examination remains valid for one calendar year from the date it is conducted, after which a new evaluation is necessary.
Medical History The form requires a detailed medical history, including past injuries, surgeries, and any ongoing health issues that may affect athletic participation.
Signature Requirement Both the athlete and their parent or guardian must sign the form, affirming that the provided information is accurate to the best of their knowledge.
Physical Examination Components The examination includes assessments of cardiovascular health, musculoskeletal function, and overall physical condition.
Clearance Categories Physicians can clear students for participation, clear them after rehabilitation, or not clear them based on their health status.
Contact Sports Specific clearance types are indicated for different levels of contact in sports, such as collision, contact, and non-contact activities.

Similar forms

  • Sports Physical Form: Similar to the Alabama High School Physical form, a sports physical form is used to assess an athlete's health before participating in sports. It includes medical history questions and a physical examination to ensure the athlete is fit for competition.
  • Preparticipation Physical Evaluation (PPE): This document serves a similar purpose as the Alabama form. It collects information about an athlete's medical history and current health status, ensuring they are ready to engage in sports activities safely.
  • Emergency Contact Form: While not a physical examination, this form is often required alongside the physical form. It provides vital information about whom to contact in case of an emergency during sports activities, ensuring athlete safety.
  • Vehicle Sale Documentation: For the transfer of vehicles that are 1972 or older, it is crucial to utilize the New York MV51 form for proper documentation. This form is essential for ensuring that the transaction is legally recognized and includes supporting documents. For more information, visit https://nytemplates.com/blank-new-york-mv51-template/.

  • Health History Questionnaire: This document is akin to the Alabama High School Physical form. It gathers comprehensive health information from the athlete, which can help identify any potential health risks before participation in sports.

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.)

Understanding Alabama High School Physical

What is the Alabama High School Physical form?

The Alabama High School Physical form is a document required for student-athletes participating in interscholastic athletics. It certifies that the student has undergone a physical examination by a licensed physician and is cleared to participate in sports. This form must be submitted to the school’s Superintendent or Principal’s office to ensure compliance with the Alabama High School Athletic Association (AHSAA) regulations.

Who needs to complete the physical form?

All students in grades 7-12 who wish to participate in interscholastic athletics must complete the physical form. This includes athletes in any sport offered by their school. It is important for the health and safety of the students, ensuring they are fit to engage in physical activities.

How often do I need to submit the physical form?

The physical examination is valid for one calendar year from the date it is performed. Therefore, students must submit a new physical form annually to maintain eligibility for participation in sports. It is advisable to schedule the physical exam well in advance of the sports season to avoid any last-minute issues.

What information is required on the physical form?

The form requires basic information such as the student’s name, age, address, school, and grade. Additionally, it includes a medical history section where the athlete must disclose any past injuries, medical conditions, or ongoing treatments. The examining physician will also provide a physical examination report, indicating the student’s fitness for sports.

What happens if the physician does not clear the student?

If the physician does not clear the student for participation, the form will indicate the specific reasons for this decision. The student may need to complete further evaluations or rehabilitation before being eligible to participate in athletics. It’s crucial to follow the physician’s recommendations to ensure the athlete’s health and safety.

Can I use a physical form from another state or organization?

No, the AHSAA requires that students use the specific AHSAA Physicians Certificate (Form 5) for their physical examination. Forms from other states or organizations may not meet the necessary requirements and could lead to eligibility issues. Always ensure that you are using the correct form to avoid complications.

Dos and Don'ts

When filling out the Alabama High School Physical form, consider the following guidelines:

  • Do provide accurate personal information, including name, age, and address.
  • Do answer all medical history questions honestly.
  • Do have a parent or guardian review the form before submission.
  • Do ensure the physician's signature is included on the form.
  • Don't leave any questions unanswered; all sections must be completed.
  • Don't falsify any information regarding medical history or previous injuries.
  • Don't forget to include emergency contact information.
  • Don't submit the form without checking for any errors or omissions.