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Fill Out Your Standard Physical Form

The Standard Physical form is a crucial document used for assessing a student-athlete's health before participation in sports. It contains sections for medical history, emergency contact information, and the examining medical professional's recommendations. Completing this form ensures that necessary measures are taken to safeguard the athlete's well-being.

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Article Structure

The Standard Physical Form serves as a vital tool for ensuring the safety and health of student-athletes participating in sports. During the examination, a medical professional evaluates key aspects such as height, weight, heart rate, and blood pressure, which provide essential insights into the athlete's physical condition. A comprehensive physical exam is conducted, assessing general appearance, cardiovascular health, respiratory function, and musculoskeletal strength. Additionally, this form documents any existing medical conditions, prior injuries, and specific health concerns, allowing for a thorough assessment of the athlete's readiness to participate. Parental consent and understanding of inherent risks in sports are integral components of the form. The form emphasizes the importance of addressing medical issues, offering various clearance recommendations, including being cleared without restrictions or requiring further evaluation. This meticulous process underscores a commitment to student-athlete safety, preparing them for a competitive yet challenging environment.

Standard Physical Example

					O.K. Conference
				Pre-Participation Physical Exam Form
		Medical Examination
	THIS SIDE TO BE COMPLETED BY EXAMINING MEDICAL PROFESSIONAL

	Name:				Date:
Ht:__________ Wt:___________ HR:___________ BP:___________ BP reck:___________
Corrective Lenses: Y or N		Vision: R________ L________

	Physical Exam	Normal	Abnormal
	General Appearance

	HEENT

	Lymph Nodes
	Heart
	Pulses

	Lungs

	Abdomen
	Skin
	Neurologic
	Spine

	Upper Extremity

	Lower Extremity
	Joint Specific (optional)
	Hernia (males only)
		COMMENTS

	General Medical			Musculoskeletal

RECOMMENDATIONS:

1.[ ] CLEARED WITHOUT RESTRICTIONS

2.[ ] Cleared for LIMITED PARTICIPATION (specify)_______________________________________

_________________________________________________________________________________

3.[ ] NOT CLEARED for participation (explanation) ________________________________________

_________________________________________________________________________________

4.[ ] Requires further evaluation before final recommendation ________________________________

_________________________________________________________________________________

I certify that I have examined the above student and recommend him/her as being able to compete in supervised athletic activity as dictated by the clearance recommendations above.

Printed Name:______________________________________________ Date:__________________

Signature:_________________________________________________ MD, DO, PA, or NP

A Current-Year Physical is one given on or after April 15 of the previous school year.

O.K. Conference

Pre-Participation Physical Exam Form

Emergency Information

		School: _____________________
Name:__________________________________ DOB:__________ Gender: M F			Grade:________
Parent/Legal Guardian Name(s):_______________________________________________________
Address:__________________________________________________________________________
Street	City	State	Zip

Phone #s: Home:__________________ Work:___________________ Cell:____________________

Emergency Contact(s):

Name:________________________________ Relationship:____________ Phone:_______________

Insurance Information:

Family Insurance Co.:__________________________________________ Phone:_______________

Contract/Group #:___________________________ Policy #:_________________________________

Parent/Legal Guardian Consent & Assumption of Risk:

Participation in interscholastic athletics requires an acceptance of risk of injury. These risks include, but are not limited to the following: death, quadriplegia, paraplegia, internal injury, closed head injury (possibly including post-concussion syndrome) and musculo-skeletal injuries (including sprains, strains, and fractures). Some of these injuries may result in medical treatment, surgery, and/or permanent disability. I understand that coaches, athletic trainers, and physicians (including side-line team physicians) will use their professional judgment when administering proper medical treatment. I have had the opportunity to ask questions, hereby recognize the risk of injury, and give my consent for my son/daughter to participate in interscholastic athletics. I further consent for the disclosure of information otherwise protected by FERPA and HIPPA for the purpose of determining eligibility for interscholastic athletics to the MHSAA, OK Conference, and school district. I also agree to accept and comply with all MHSAA, OK Conference, and school district athletic policies.

Parent/Legal Guardian Signature:_______________________________________ Date:___________

Student-Athlete Signature:_____________________________________________Date:___________

Authorization of Treatment:

I, ________________________________, hereby give my permission for my son/daughter, ____________________________,

to undergo medical treatment for any injury or illness he/she may sustain or acquire while participating in interscholastic athlet- ics. I understand that medical personnel, including athletic trainers and sideline team physicians, will perform only those proce- dures within their training, credentialing, and scope of professional practice to prevent, care for, and rehabilitate athletic injuries or illnesses. In the event more serious medical treatment/procedures are required and I cannot be reached for my consent, I authorize any licensed medical practitioner to perform such treatments/procedures medically necessary to alleviate the problem.

Parent/Legal Guardian Signature:_______________________________________ Date:___________

A Current-Year Physical is one given on or after April 15 of the previous school year.

Medical History
1. Do you have any chronic or ongoing medical conditions?	Yes	No

If yes, explain:____________________________________________________________________

2. Have you ever been hospitalized and/or had surgery for any reason?Yes No If yes, explain:____________________________________________________________________

3. Do you have any allergies (medications, insects, foods, etc.)?Yes No If yes, explain:____________________________________________________________________

4. Are you currently taking any medications or supplements (include over-the-counter)? Yes No If yes, explain:____________________________________________________________________

5. Have you had a medical problem or injury since your last physical exam?Yes No If yes, explain;____________________________________________________________________

6. Have you ever passed out or nearly passed out during or after exercise?	Yes	No
Have you ever had chest pain, tightness, or pressure during or after exercise?	Yes	No
Have you ever been dizzy or light headed during or after exercise?	Yes	No
Do you get more tired or short of breath than others during exercise?	Yes	No
Does your heart ever race or skip beats (irregular beats) during exercise?	Yes	No
Has a doctor ever ordered a test for your heart (e.g. ECG/EKG, echocardiogram?	Yes	No

Have you ever been told you have any of the following (check all that apply):

High blood pressure	Heart murmur	High cholesterol
A heart infection	Kawasaki disease	Other:_____________________

Explain ALL yes answers & checked items:_____________________________________________

_______________________________________________________________________________

7. Has anyone in your family died suddenly OR of heart problems before age 50?	Yes	No
Do anyone in your family have a heart problem, pacemaker, or implanted defibrillator? Yes		No
Has anyone in your family had unexplained fainting, seizures, or near drowning?	Yes	No

Does anyone in your family have any of the following cardiovascular conditions:

Hypertrophic cardiomyopathy	Marfan syndrome	Brugada syndrome
Arrythmogenic right ventricular cardiomyopathy		Long QT syndrome
Catecholaminergic polymorphic ventricular tachycardia		Short QT syndrome

Explain ALL yes answers & checked items:_____________________________________________

_______________________________________________________________________________

8. Have you ever had a concussion, head injury, or recurrent headaches?Yes No If yes, explain:____________________________________________________________________

Have you ever been knocked out or unconscious?Yes No If yes, explain:____________________________________________________________________

Do you have headaches with exercise?Yes No If yes, explain:____________________________________________________________________

Have you ever had any of the following after a hit, blow to the head, or falling:

Confusion

Prolonged headache

Inability to move your arms or legs

Memory problems Numbness, tingling, or weakness in your arms or legs

Explain ALL checked items (include dates):_____________________________________________

_______________________________________________________________________________

Have you ever had a stinger, burner, or pinched nerve?Yes No If yes, explain:____________________________________________________________________

Have you ever had seizures, convulsions, or a history of epilepsy?Yes No If yes, explain:____________________________________________________________________

9. Have you ever become ill, dizzy, or passed out while exercising in the heat?Yes No If yes, explain:____________________________________________________________________

Do you get frequent muscle or heat cramps when exercising?Yes No If yes, explain:____________________________________________________________________

Do you or someone in your family have sickle cell trait or disease?Yes No If yes, explain:____________________________________________________________________

10.Do you or someone in your family have asthma or another obstructive lung disorder? Yes No If yes, explain:____________________________________________________________________

Do you cough, wheeze, or have difficulty breathing during or after exercise?Yes No If yes, explain:____________________________________________________________________

Have you ever used an inhaler or taken asthma medication?Yes No If yes, explain:____________________________________________________________________

11.Do you currently have, or have you EVER HAD any of the following:

Hernia Mononucleosis Diabetes Kidney disease Scoliosis Absent spleen Explain ALL checked items (include dates):_____________________________________________

_______________________________________________________________________________

12.Are you missing one of a set of paired organs (kidneys, eyes, ovaries, testes, etc.)? Yes No If yes, explain:____________________________________________________________________

13.Have you ever sprained, strained, dislocated, fractured, broken, experienced repeated swelling in, had a stress fracture in, or otherwise injured any bones or joints? (check all that apply)

Head	Neck	Chest/ribs	Back	Shoulder	Forearm	Elbow Wrist
Hip	Thigh	Calf/shin	Knee	Ankle	Foot/toes	Hand/fingers

Explain ALL checked answers (include dates):__________________________________________

_______________________________________________________________________________

14.Have you ever had a condition/injury that required x-rays, MRI, CT scan, or therapy? Yes No If yes, explain:____________________________________________________________________

15.Do you use any special equipment (braces, pads, mouthguards, neck rolls, etc.)? Yes No If yes, explain:____________________________________________________________________

16.Have you had any problems with your vision or injuries to your eyes?	Yes	No
Do you wear glasses, corrective lenses, or protective eyewear?	Yes	No

Explain ALL yes answers:___________________________________________________________

17.Have you ever had any skin problems (rashes, itching, MRSA, herpes, acne)?Yes No If yes, explain:____________________________________________________________________

18.Have you ever had an eating disorder or restricted food to lose weight?	Yes	No
Do you want to weigh MORE or LESS than you do now?	Yes	No
Do you feel stressed?	Yes	No

Explain ALL yes answers:___________________________________________________________

20.FEMALES ONLY Age at 1st menstrual period?___________ Date of most recent?____________

Number of periods in the last 12 months?________ Longest time between periods?__________

21.Has a doctor ever denied or restricted your participation in sports for any reason? Yes No If yes, explain;____________________________________________________________________

**I hereby state that, to the best of my knowledge, the answers to the above questions are complete and correct.

Signature of Athlete:_____________________________________________ Date:_____________

Signature of Parent/Guardian:______________________________________ Date:____________

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Form Characteristics

Fact Name	Description
Form Title	The form is known as the "O.K. Conference Pre-Participation Physical Exam Form." It serves as an essential document for student-athletes.
Purpose	This form aims to assess the medical eligibility of student-athletes for participation in sports activities.
Governing Laws	The form aligns with state laws governing interscholastic athletics, particularly the Michigan High School Athletic Association (MHSAA) guidelines.
Physical Examination	It requires a thorough medical assessment, including height, weight, heart rate, and blood pressure.
Medical History	Student-athletes must disclose any chronic medical conditions, surgeries, allergies, or medications.
Emergency Information	The form requests essential emergency contact details, including parents' names and phone numbers.
Assumption of Risk	Parents and guardians must acknowledge the potential risks associated with athletic participation, including severe injuries.
Current-Year Physical	A current-year physical must be conducted on or after April 15 of the previous school year.
Signature Requirement	Both the parent/guardian and student-athlete must sign the form, confirming their understanding and consent.
Recommendations Section	This section includes options for medical clearance, which can be without restrictions, with limitations, or denial of participation.

Guidelines on Utilizing Standard Physical

Completing the Standard Physical form is a crucial step in ensuring student-athletes are prepared for participation in sports activities. Ensuring all sections are filled accurately will assist medical professionals in evaluating health and safety standards.

Start with the section for the medical professional. Fill in the student’s name, date, height, weight, heart rate, and blood pressure.
Indicate if corrective lenses are needed and record vision for both eyes.
Check the box marked "Normal" or "Abnormal" for each physical exam category: General Appearance, HEENT, Lymph Nodes, Heart, Pulses, Lungs, Abdomen, Skin, Neurologic, Spine, Upper Extremity, Lower Extremity, Joint Specific, and Hernia (for males).
Provide any additional comments regarding the physical exam findings.
Select one of the recommendations regarding the student’s clearance for participation: cleared without restrictions, cleared for limited participation, not cleared, or requires further evaluation.
The examining medical professional must print their name, date, and sign where indicated.
Move on to the Emergency Information section. Fill in the school name, student name, date of birth, gender, and grade.
Provide the names, addresses, and phone numbers of the parent or legal guardian, emergency contacts, and family insurance information.
Have the parent or legal guardian sign the consent and assumption of risk section, and follow with the student-athlete’s signature.
Complete the Authorization of Treatment by having the parent or legal guardian sign where noted.
Next, answer all questions in the Medical History section, providing detailed explanations where necessary for any "Yes" answers.
Lastly, gather the signatures of both the athlete and the parent/guardian at the end of the Medical History section.

What You Should Know About This Form

What is the Standard Physical form used for?

The Standard Physical form is designed to assess the health and medical history of a student-athlete before participating in interscholastic athletics. It ensures that athletes are medically cleared to engage in sports activities, acknowledging any existing medical conditions that may need to be addressed.

Who is responsible for completing the medical examination section of the form?

A licensed medical professional, such as a medical doctor (MD), doctor of osteopathy (DO), physician assistant (PA), or nurse practitioner (NP), is responsible for completing the medical examination section. This professional evaluates the student-athlete's health and provides recommendations regarding participation in athletic activities.

What does "Current-Year Physical" mean?

A "Current-Year Physical" refers to an examination conducted on or after April 15 of the previous school year. This ensures that the medical assessment is current and relevant for the upcoming athletic season.

What should a parent or guardian know about the risks of injury associated with athletic participation?

A parent or guardian should recognize that participation in interscholastic athletics includes inherent risks, such as serious injuries and conditions, which may even lead to permanent disability or death. The form includes a consent section, where guardians acknowledge these risks and agree to their child’s participation.

What information is required regarding emergency contacts on the form?

The form requires the names and phone numbers of at least two emergency contacts. This ensures that medical professionals have alternative contacts in case of emergencies during athletic events or training sessions.

How should athletes report their medical history?

Athletes must answer various questions concerning their medical history, including past surgeries, chronic conditions, allergies, and any history of injuries. Honest and comprehensive responses are critical, as they guide medical professionals in assessing the athlete's fitness for participation.

What actions should be taken if a student-athlete is not cleared for participation?

If a student-athlete is not cleared for participation, the medical professional is required to provide an explanation. It is advisable to seek further evaluation or treatment as necessary before reapplying for clearance to ensure the student's safety and well-being.

Can a student-athlete participate without the parent or guardian's signature on the form?

No, a student-athlete cannot participate in interscholastic athletics without the parent or guardian's signature on the form. This signature indicates informed consent and the understanding of the associated risks with athletic participation.

Common mistakes

Filling out the Standard Physical form is a crucial step for student-athletes. However, several common mistakes can hinder the process. Understanding these errors can help ensure that the form is completed accurately. One prevalent mistake involves insufficient detail in the medical history section. Individuals might answer “yes” to important questions but fail to provide adequate explanations. This lack of clarity can lead to confusion during the evaluation, potentially resulting in an incorrect assessment of the athlete’s health.

Another common error relates to the emergency contact information. Many people overlook this area or enter incomplete details. In the event of an injury or health emergency, the absence of correct contact information can delay vital medical assistance. It’s essential to ensure that all fields are filled out completely, including alternative contacts, which could be crucial if the primary contact is unavailable.

Some may neglect the requirement for a current-year physical. The form specifies that the examination must occur on or after April 15 of the previous school year. Failing to adhere to this guideline can mean that the submitted physical is invalid, causing delays in eligibility for participation in sports. It is vital for parents and guardians to verify the date when the physical was conducted before submission.

In addition to these oversights, individuals often misread the clearance recommendations. It is not uncommon for a parent or guardian to submit the form with an unclear understanding of the athlete’s status. The options range from being “cleared without restrictions” to “not cleared for participation.” Misinterpreting these recommendations can affect the athlete’s preparedness for competition and may lead to frustration or even health risks if the restrictions are not observed.

Lastly, many individuals fail to secure all necessary signatures. The form requires signatures from both the student-athlete and their parent or guardian. Without these endorsements, the form may be deemed incomplete, causing unnecessary delays. Ensuring proper signatures not only affirms the athlete's readiness for competition but also showcases parental involvement and understanding of the associated risks.

Documents used along the form

The Standard Physical form is a vital document for assessing the health and readiness of student-athletes to participate in sports. In addition to this form, several supplementary documents are typically required to ensure the safety and preparedness of each athlete. Below is a list of commonly used forms and documents associated with the Standard Physical form.

Emergency Contact Form: This form captures critical information regarding the student's guardians and emergency contacts, including their phone numbers and relationships to the student, to ensure timely communication in case of an emergency.
Insurance Information Form: This document contains details about the student's insurance provider, including the company name, policy number, and contact phone number, to facilitate any necessary medical care.
Parental Consent Form: This form grants permission for the student to participate in athletic activities. It acknowledges the risks associated with sports participation and ensures that guardians have informed themselves about those risks.
Authorization for Treatment Form: This document provides authorization for medical personnel to administer treatment to the student in case of injury or illness during athletic activities, even in the absence of the guardian.
Medical History Questionnaire: This form gathers comprehensive medical history from the student, including chronic conditions, past hospitalizations, allergies, and medications, to help healthcare providers assess any potential issues.
Clearance Letter: This letter, typically issued by a healthcare provider, formally indicates whether a student is cleared for sports participation based on their physical examination and medical history.
Concussion Information Form: This document outlines the symptoms and risks associated with concussions, providing valuable information for both athletes and parents to promote awareness and prevention.
Heat Acclimatization Acknowledgment: This form discusses the importance of acclimatizing to hot weather and requires signatures from both the athlete and parents to acknowledge understanding of the associated risks.

These accompanying forms and documents collectively ensure that the necessary precautions are taken for the health and safety of student-athletes. Proper completion of each form is essential for a comprehensive overview of an athlete’s readiness for participation.

Similar forms

The Standard Physical Form serves a crucial role in ensuring the health and safety of student-athletes. It collects essential information regarding an individual's medical history and current health status before participating in sports. Several other documents carry similar purposes, providing a comprehensive view of an athlete's readiness to engage in physical activities. Below are four documents that share similarities with the Standard Physical Form:

Annual Health Questionnaire: This document gathers detailed medical information from athletes annually. It addresses ongoing conditions, previous injuries, and allergies, much like the comprehensive medical history section in the Standard Physical Form.
Pre-Participation Evaluation (PPE) Form: Similar to the Standard Physical Form, the PPE focuses on evaluating an athlete’s overall health. It often includes a physical examination by a healthcare provider and recommendations for participation, ensuring that athletes are fit for sports.
Emergency Contact Form: This document is critical as it provides information on whom to contact in case of an emergency. Like the Standard Physical Form, it collects essential details about the student's guardians and emergency contacts, helping manage potential risks during sports activities.
Consent and Assumption of Risk Waiver: This form is signed by parents or guardians, acknowledging the risks associated with athletic participation. It parallels the consent section of the Standard Physical Form where parental agreement is necessary for participation, ensuring that families are aware of possible injuries.

Dos and Don'ts

Filling out the Standard Physical form efficiently can make a considerable difference in ensuring a smooth and successful process for student-athletes. Below are some important do's and don'ts to keep in mind while completing this form.

DO ensure all personal and medical history information is accurate and complete. This helps your healthcare provider make informed recommendations.
DO sign and date both the student-athlete and the parent/legal guardian sections. Without these signatures, the form may not be considered valid.
DO communicate any changes in health or medication since your last physical. Transparency can prevent complications during athletic participation.
DO double-check the dates. Ensure that the physical is current, meaning it should be conducted on or after April 15 of the previous school year.

DON'T leave any questions unanswered. It is important to provide a complete picture of health.
DON'T rush through the form. Take your time to ensure all information is filled out thoughtfully and accurately.
DON'T forget to disclose any past injuries or medical conditions, even if they seem minor. They can impact physical activity.
DON'T ignore instructions provided on the form. Following guidelines can ease the burden on medical staff and ensure better care.

By adhering to these guidelines, you can enhance the effectiveness of the physical examination process, promoting the safety and well-being of the student-athlete.

Misconceptions

Here are some common misconceptions about the Standard Physical form that you may encounter:

It's only needed for high school athletes. This form is required for all athletes participating in interscholastic athletics, regardless of grade level. Elementary and middle school students involved in sports must also have a current physical on file.
Only the student-athlete needs to fill it out. While it is crucial for the student to provide information about their health, the form also requires input from a parent or legal guardian. Their signature is necessary to give consent for participation and acknowledge the associated risks.
It can be completed at any time during the school year. There are specific timeframes for when a physical is considered current. A physical must be conducted on or after April 15 of the previous school year to be valid for the upcoming sports season.
The physical exam is just a formality. It's vital to understand that the physical exam serves a crucial purpose. It assesses the athlete’s ability to participate in sports safely and can help identify any potential health issues that may require further evaluation.
One physical examination is enough for all sports. An athlete may require multiple evaluations if they are participating in different sports that have varying physical demands. Additionally, if health conditions change, an updated physical may also be necessary.

Key takeaways

This list summarizes key points regarding the Standard Physical form that must be filled out and utilized effectively.

The form must be completed by a licensed medical professional.
It requires basic patient information, including name, date of birth, and contact details.
Ensure that the physical examination results, such as height, weight, and vital signs, are accurately recorded.
Providers must check for any abnormalities and provide comments on the physical exam.
Recommendations for participation include options: cleared without restrictions, cleared for limited participation, not cleared, or requires further evaluation.
It's necessary to complete the medical history section thoroughly, disclosing any chronic conditions or previous injuries.
The form includes important parental consent sections regarding risk acceptance and the authorization of treatment.
A current year physical must be dated on or after April 15 of the previous school year.
Detailed answers are essential in sections concerning cardiovascular and neurological assessments, especially regarding family medical history.
All signatures from both the student-athlete and parent/guardian are crucial to validate the form.

Completing this form accurately and promptly ensures the safety and eligibility of each student-athlete for participation in sports.

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