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The Alabama High School Physical form plays a crucial role in ensuring the health and safety of student-athletes participating in interscholastic sports. This form is designed to gather essential information regarding a student's medical history and current health status, helping to identify any potential risks before they engage in physical activities. Key sections of the form include personal details such as the athlete's name, age, and school, along with inquiries about past injuries, surgeries, and existing medical conditions. Questions address a wide range of health issues, from allergies and respiratory problems to musculoskeletal concerns, ensuring that a comprehensive evaluation is conducted. Furthermore, the form requires a physical examination by a licensed physician, who must certify that the student is fit to participate in sports. This certification remains valid for one calendar year, emphasizing the importance of regular health assessments. By completing the Alabama High School Physical form, both athletes and their guardians take an important step in safeguarding their well-being while promoting a culture of safety in school athletics.

Common mistakes

  1. Incomplete Personal Information: Failing to provide all necessary personal details, such as name, age, and address, can delay processing. Ensure that every section is filled out completely.

  2. Missing Signatures: Both the athlete and the parent/guardian must sign the form. Omitting one of these signatures can render the form invalid.

  3. Not Disclosing Medical History: It’s crucial to answer all medical history questions accurately. Omitting past injuries or conditions can lead to complications during participation.

  4. Incorrect Physician Information: Providing inaccurate details about the physician, such as name or contact information, can cause issues if verification is needed later.

  5. Failure to Update Information: If there are changes in the athlete's health or medical history after the form is submitted, it is important to update the information immediately.

  6. Not Keeping a Copy: Failing to keep a copy of the completed form can lead to problems. Always retain a duplicate for your records.

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Key takeaways

Filling out and utilizing the Alabama High School Physical form is a crucial step for student-athletes. Here are some key takeaways to ensure a smooth process:

  • Complete Personal Information: Make sure to fill in all personal details accurately, including name, age, address, and school. This information is essential for identification and record-keeping.
  • Medical History Matters: The form requires a comprehensive medical history. Be honest and thorough about any past injuries, surgeries, or ongoing health issues. This ensures the physician can make an informed evaluation.
  • Parental Consent: Both the athlete and a parent or guardian must sign the form. This signature indicates that the information provided is correct and that the parent is aware of the athlete's participation in sports.
  • Physician's Examination: A licensed physician (M.D. or D.O.) must conduct the physical examination. This step is not just a formality; it helps identify any potential health risks.
  • Certification of Clearance: The physician must indicate whether the athlete is cleared for participation. This includes specifying if the clearance is conditional or if there are any restrictions.
  • Validity Period: Remember that the physical exam results are valid for one calendar year. Schedule follow-up evaluations as needed to maintain eligibility.
  • Documentation Submission: After completing the form, submit it to the school’s Superintendent or Principal's office. This is vital for ensuring the athlete's eligibility for interscholastic athletics.
  • Stay Informed: Keep a copy of the completed form for personal records. This helps track any medical changes and provides a reference for future physicals.

Understanding these key aspects will help ensure that student-athletes are well-prepared for their sporting endeavors while prioritizing their health and safety.

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

  1. What is the Alabama High School Physical form?

    The Alabama High School Physical form is a document required for students participating in interscholastic athletics in Alabama. It certifies that a student has undergone a physical examination by a licensed physician and is cleared to participate in sports. This form ensures that the athlete is in good health and can safely engage in physical activities.

  2. Who needs to fill out the form?

    All students in grades 7-12 who wish to participate in interscholastic athletics must complete the Alabama High School Physical form. This includes students involved in any sport, whether it's football, basketball, soccer, or track and field.

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

    The physical examination is valid for one calendar year from the date of the exam. Therefore, students must submit a new form each year to remain eligible for participation in sports.

  4. What information is required on the 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 parents or guardians must disclose any past injuries, illnesses, or conditions that may affect the student's ability to participate in sports.

  5. What if my child has a medical condition?

    If your child has a medical condition, it's crucial to provide detailed information on the form. The examining physician will assess whether the condition affects the student's ability to participate in sports. The physician may clear the student for participation with restrictions or recommend further evaluation or rehabilitation.

  6. Who can perform the physical examination?

    The physical examination must be conducted by a licensed physician, either an M.D. (Doctor of Medicine) or a D.O. (Doctor of Osteopathic Medicine). This ensures that the evaluation is thorough and meets the requirements set by the Alabama High School Athletic Association (AHSAA).

  7. Where should I submit the completed form?

    The completed form should be submitted to the Superintendent's or Principal's office at the student's school. It is essential to ensure that the form is on file before the student participates in any athletic activities.

  8. What happens if the form is not submitted?

    If the form is not submitted, the student will not be eligible to participate in interscholastic athletics. Schools require this documentation to ensure the safety and well-being of all student-athletes.

  9. Can I get a copy of the form?

    Yes, you can usually obtain a copy of the Alabama High School Physical form from your school’s athletic department or the AHSAA website. It's advisable to keep a copy for your records as well.

  10. Is there a fee for the physical examination?

    Fees for the physical examination can vary depending on the healthcare provider. It’s best to check with your physician's office to understand any costs associated with the exam.

How to Use Alabama High School Physical

Filling out the Alabama High School Physical form is an important step for student-athletes. This form collects essential information about the athlete’s health history and ensures they are fit to participate in sports. Follow these steps to complete the form accurately.

  1. Begin by entering the athlete's name, sex, and age at the top of the form.
  2. Fill in the address and school information, along with the grade the athlete is in.
  3. Answer the questions regarding any past medical issues. Indicate if the athlete has ever had problems such as sprains, strains, or concussions.
  4. For each “Yes” answer, provide additional details in the space provided. Be clear and concise.
  5. Record the date of birth and phone number of the athlete.
  6. Select the sport the athlete will be participating in.
  7. Sign and date the form where indicated, confirming that all information is accurate.
  8. Have a parent or guardian sign the form as well, acknowledging the information provided.
  9. Ensure that the form is submitted to the appropriate school official for review.

Once the form is filled out and submitted, it will be reviewed by a physician. The physician will conduct a physical examination and provide their clearance for the athlete to participate in sports. Make sure to keep a copy of the form for your records, as it may be required for future participation.