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Fill Out a Valid Alabama High School Physical Template

The Alabama High School Physical Form is a critical document designed for student-athletes participating in interscholastic sports. It ensures that each athlete receives a thorough physical evaluation by a licensed physician, confirming their fitness to engage in athletic activities. Completing this form is essential for compliance with state regulations and for the safety of the students involved.

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Content Overview

Guide to Writing Alabama High School Physical

Completing the Alabama High School Physical form is an essential step for student-athletes before participating in sports. This process ensures that all necessary health information is accurately recorded, helping to safeguard the well-being of the student. Below are the steps to guide you through filling out the form correctly.

Gather Required Information: Collect personal details such as your name, age, address, school, and grade.
Complete the History Section: Answer all questions related to your medical history. Be honest about any past injuries, surgeries, or ongoing health issues.
Provide Details for "Yes" Answers: If you answer "Yes" to any questions, explain the circumstances in the space provided. Include dates and any relevant details.
Fill Out the Physical Examination Section: This part will be completed by a licensed physician. Ensure they check all necessary health metrics such as height, weight, and heart rate.
Obtain Physician's Clearance: The physician will indicate whether you are cleared for participation in sports. They will also provide recommendations if necessary.
Sign the Form: Both the athlete and a parent or guardian must sign the form to confirm that the information is accurate and that you understand the requirements.
Submit the Form: Turn in the completed form to your school’s athletic department or the appropriate office as specified.

Document Breakdown

Fact Name	Fact Description
Governing Body	The Alabama High School Athletic Association (AHSAA) oversees the physical evaluation requirements for high school athletics in Alabama.
Eligibility Requirement	Students in grades 7 through 12 must have a current physician's statement on file to participate in interscholastic athletics.
Form Usage	The AHSAA requires the use of the AHSAA Physicians Certificate (Form 5) for all physical evaluations.
Validity Period	A physical examination is valid for one calendar year from the date it was performed.
Medical History	The form includes questions about the athlete's medical history, including past injuries and existing health conditions.
Signature Requirement	Both the athlete and a parent or guardian must sign the form, affirming the accuracy of the provided information.
Physical Examination Components	The physical evaluation includes checks on cardiovascular health, musculoskeletal condition, and other vital signs.
Clearance Categories	Physicians can clear athletes for participation, clear them with conditions, or not clear them at all based on their evaluation.

FAQ

What is the purpose of the Alabama High School Physical form?

The Alabama High School Physical form is designed to assess a student's physical health and readiness for participation in interscholastic athletics. It ensures that students are evaluated by a physician to confirm they are fit to engage in sports activities, thereby promoting safety and well-being.

Who needs to complete the physical form?

All students in grades 7 through 12 who wish to participate in interscholastic athletics are required to complete the physical form. This includes students involved in all sports, regardless of the level of competition.

How often does a student need to submit the physical form?

A physical exam is valid for one calendar year from the date of the exam. Therefore, students must submit a new physical form annually to ensure compliance with eligibility requirements.

What information is required on the physical form?

The form requires basic information such as:

Name
Sex
Age
Address
School
Grade

Additionally, it includes a medical history section where students must disclose any past injuries, medical conditions, or surgeries.

What does the physical examination entail?

The physical examination includes assessments of various body systems, such as cardiovascular, musculoskeletal, and respiratory systems. The examining physician will check vital signs, height, weight, and overall physical condition to determine fitness for sports participation.

What happens if a student is not cleared for participation?

If a student is not cleared for participation, the physician will specify the reasons on the form. The student may need to complete further evaluations or rehabilitation before being eligible to participate in sports.

Who can conduct the physical examination?

The physical examination must be performed by a licensed physician, either an M.D. (Doctor of Medicine) or a D.O. (Doctor of Osteopathy). This ensures that the evaluation is conducted by a qualified medical professional.

Is a parent or guardian required to sign the form?

Yes, a parent or guardian must sign the physical form. This signature indicates that they acknowledge the information provided and consent to the student's participation in athletics.

Where should the completed physical form be submitted?

The completed physical form should be submitted to the Superintendent's or Principal's office of the student's school. It must be on file to confirm the student's eligibility for participation in interscholastic athletics.

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Alabama High School Physical Example

ALABAMA HIGH SCHOOL ATHLETIC ASSOCIATION	Revised 2018
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?
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
			Student's name		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
Physical Examination					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
			Vision R 20 / ____ L 20 / ____ Corrected: Y N

		LIMITED		Normal		Abnormal Findings

			Cardiovascular
			Cardiovascular

			Pulses

			Heart

			Lungs

			Skin

			E.N.T.

	COMPLETE		Abdominal

			Genitalia (males)
			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.)