When an FHSAA ECG screening (EL1) or preparticipation physical (EL2) refers a Florida student-athlete for further evaluation, this one-page form records the specialist's findings and clearance. It replaced page five of the EL2 in 2026. The specialist notes the reason for referral, the diagnosis and one of four eligibility outcomes before athletic clearance can be granted.
The referred specialist, or a clinician under their direct supervision, completes the evaluation section and signs with credentials and license number. The student and parent fill in student, emergency contact and family provider details.
Download the current version from the source each time; forms change without notice.
Medical Eligibility Supplemental Form
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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It is required when a student must be evaluated by a qualified medical specialist before clearance, after a referral from either the EL1 ECG Screening Form or the EL2 Preparticipation Physical Evaluation. All applicable sections must be completed by the specialist before athletic clearance may be granted.
It depends on which form it supplements. For an EL1 ECG referral, the form is required only one time. For an EL2 physical referral, it is valid for 365 calendar days from the date of the exam, in line with the physical itself.
No. FHSAA removed page five of the EL2 and replaced it with the EL1/2s. The first four pages of the EL2 are unchanged, and FHSAA says the previous version of the EL2 can still be used.