LHSAA requires this medical history evaluation and physical exam every year for Louisiana high school athletes, kept on file at the school and subject to inspection by the association's Rules Compliance Team. Page 1 holds the family and athlete history and a parents' waiver; page 2 is the provider's limited screening exam and medical eligibility decision.
An MD, DO, APRN or PA completes the page 2 exam and eligibility section and signs. The parent completes the page 1 history and waiver and answers four consent questions.
Download the current version from the source each time; forms change without notice.
LHSAA Physical Exam/Medical History Form (Medical History Evaluation)
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The form states the physical expires 13 months from the date it was signed and dated by the MD, DO, APRN or PA. LHSAA also requires the form to be completed annually and kept on file at the school, where it is subject to inspection.
Page 2 is completed annually by a medical doctor, osteopathic doctor, nurse practitioner (APRN) or physician assistant, who prints their name, signs and enters the date of the medical examination.
LHSAA posts a version with the first page, the history and waiver, in Spanish. The provider's exam page follows the same layout, and the association also offers one-page and two-page English versions on its forms page.