Preparticipation Physical Evaluation Forms - History and Exam
The file contains forms for a preparticipation physical evaluation, including both a history form and an examination form. It is intended to be completed by the patient and medical provider respectively before participation in sports activities. The questions cover medical history, heart health, bone and joint health, and other relevant medical concerns.
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How do I fill this out?
Filling out this form is an important step before participating in sports. Begin by thoroughly answering all questions on the history form, ideally with the assistance of a parent if you are a minor. Ensure honesty and completeness in your answers for accurate medical evaluation.
How to fill out the Preparticipation Physical Evaluation Forms - History and Exam?
1
Start by entering your personal information such as name, date of birth, and the sport you are participating in.
2
Answer all the questions regarding your medical history, surgeries, allergies, and current medications.
3
Complete the health questionnaire by circling the appropriate responses.
4
Explain any 'Yes' answers in the space provided at the end of the form.
5
Sign the form and have your guardian sign if you are a minor.
Who needs the Preparticipation Physical Evaluation Forms - History and Exam?
1
Students participating in sports need this form for preparticipation medical evaluation.
2
Parents of student athletes should complete this form to provide accurate medical history information.
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Medical providers use this form to assess the athlete’s health and eligibility for sports participation.
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Schools and sports organizations require this form to ensure the safety and well-being of their athletes.
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Coaches may need this form to understand any medical issues or restrictions for their athletes.
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What are the instructions for submitting this form?
Submit the completed preparticipation physical evaluation form to your school's athletic department or sports organization. You can email the form to the provided email address or submit it through the online submission form if available. Alternatively, you can fax the form to the provided fax number or deliver a physical copy to the athletic office. Ensure all required sections are completed and signed.
What are the important dates for this form in 2024 and 2025?
Ensure to submit the preparticipation physical evaluation forms before the start of the sports season. Deadlines may vary based on your school or sports organization, so check with them for specific dates in 2024 and 2025.
What is the purpose of this form?
The purpose of the preparticipation physical evaluation form is to ensure that athletes are in good health and capable of participating in sports activities. By providing detailed medical history and undergoing a physical exam, potential health risks can be identified and managed. This form helps protect the well-being of athletes and allows medical providers to make informed decisions about their eligibility for sports.
Tell me about this form and its components and fields line-by-line.
- 1. Name: Field for the athlete's name.
- 2. Exam Date: Field for the date of the examination.
- 3. Date of Birth: Field for the athlete's date of birth.
- 4. Sport(s): Field to list the sports the athlete participates in.
- 5. Sex assigned at birth: Options to select the sex assigned at birth.
- 6. Identified Gender: Options to select the athlete's identified gender.
- 7. Past and Current Medical Conditions: Field to list any past and current medical conditions.
- 8. Surgical Procedures: Field to list all past surgical procedures.
- 9. Allergies: Field to list any allergies the athlete has.
- 10. Current Prescriptions and Supplements: Field to list all current prescriptions, over-the-counter medicines, and supplements.
- 11. Patient Health Questionnaire (PHQ-4): Questions to assess the athlete's mental health over the past 2 weeks.
- 12. General Questions: General health questions to be answered by the athlete.
- 13. Heart Health Questions About You: Questions related to the athlete's heart health.
- 14. Heart Health Questions About Your Family: Questions related to the heart health of the athlete's family members.
- 15. Bone and Joint Questions: Questions about injuries to bones, muscles, ligaments, joints.
- 16. Medical Questions: Additional medical questions regarding the athlete's health.
- 17. Females Only: Questions specifically for female athletes about their menstrual periods.
- 18. Explain 'Yes' answers: Section to explain any 'Yes' answers provided.
- 19. Signature of Athlete: Field for the athlete's signature.
- 20. Signature of Guardian: Field for the guardian's signature if the athlete is a minor.
What happens if I fail to submit this form?
If you fail to submit the preparticipation physical evaluation form, you may not be allowed to participate in sports activities. This form is crucial for determining your health and safety during sports.
- Ineligibility: You may be deemed ineligible to participate in sports activities without a completed form.
- Health Risks: Unidentified health issues could pose risks during physical exertion.
- Non-Compliance: Failure to comply with school or sports organization requirements.
How do I know when to use this form?
- 1. Before Sports Season: Complete the form before the sports season starts.
- 2. When Joining New Sports: Use the form when participating in a new sport for the first time.
- 3. Annual Health Check: It may be required annually for ongoing sports participation.
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What types of fields are included in the history form?
The history form includes fields for personal information, medical history, surgeries, allergies, current medications, and a health questionnaire.
Do I need my parent's signature on the form?
Yes, if you are a minor, a guardian's signature is required at the end of the history form.
What should I do if I don't know the answer to a question?
Circle the question you don't know and discuss it with your medical provider during your appointment.
Are there additional questions that the medical provider might ask?
Yes, the provider may ask additional questions about sensitive issues such as stress, drug use, and safety at home.
What does the examination form include?
The examination form includes sections for height, weight, vision, blood pressure, and a detailed medical examination checklist.
Can I submit the form online after completing it?
Yes, after you have filled out and signed the form on PrintFriendly, you can submit it online via email or other submission forms provided by your organization.
