The Arkansas Activities Association posts this one-page physical examination form among its student medicine forms for interscholastic athletes. It follows the 2019 preparticipation physical evaluation exam page: vitals, medical and musculoskeletal findings, functional testing and a clearance decision. It pairs with the AAA history form, which the student and family complete in English or Spanish before the visit.
The examining physician, APN or PA completes the exam and clearance and signs. The student and parent complete the separate Physical Exam Form - History.
Download the current version from the source each time; forms change without notice.
Physical Exam Form - Evaluation
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The signature line reads physician, APN or PA, so an advanced practice nurse or physician assistant can complete and sign the exam as well as a physician. The provider prints name, address, phone and date of exam.
AAA posts the history portion, Physical Exam Form - History, in English and Spanish. The evaluation page that the provider completes is posted in English, so a Spanish-speaking family can complete the history in Spanish and the provider completes the English exam page.
Yes. The attestation states that if conditions arise after the athlete has been cleared, the physician may rescind the clearance until the problem is resolved and the potential consequences are completely explained to the athlete and parents or guardians.