After a preparticipation physical evaluation, the examining clinician uses this two-page form to tell a school or sports organization whether the athlete is medically eligible for all, some or no sports. The AAP and its partner societies call it the only PPE form that should go to nonmedical personnel, so the history and physical examination forms stay with the clinician. The 6th edition expands the shared emergency information and adds a guardian acknowledgment to share it.
The examining MD, DO, NP or PA completes the shared emergency information, the eligibility decision and recommendations, and signs the attestation. A legal guardian checks the acknowledgment authorizing sharing with the school and coaches, signs, and lists emergency contacts.
Enter the athlete's name and date of birth, then check every condition that applies: anaphylaxis, asthma, cardiac condition, concussion history, diabetes, heat stroke or rhabdomyolysis, missing organ, POTS, seizures, sickle cell disease, sickle cell trait, stinger history or other, with details. Record known triggers for those conditions, such as exercise or weather, and environmental and food allergies. School staff see this section, so it should hold what they need in an emergency.
List emergency medications, such as an inhaler or epinephrine auto-injector, and medications used before, during or after activity, such as an inhaler before exercise or insulin. Describe activity modifications, for example limiting exertion, monitoring symptoms or extra hydration breaks, and add anything else coaches and athletic staff should follow during practice and competition.
Check one: eligible for all sports and activities without restriction; eligible without restriction but with recommendations for further evaluation or treatment of a named issue; eligible after evaluation and clearance for a named condition; eligible for certain sports and activities, listing the specific sports or type; or not eligible for any sports or activities. Options that call for detail need the condition or sports written in.
Use the recommendations lines for follow-up, referrals or other guidance tied to the eligibility decision, such as the evaluation the athlete needs before clearance or limits that apply to certain sports. These lines are on the page that goes to the school, so they should be written for nonmedical readers.
The printed statement confirms you examined the student, completed the evaluation, found no apparent clinical contraindications to the sports outlined, keep the examination findings on record and can make them available to the school at the parents' request, and may rescind eligibility if conditions arise. Print your name, date, address and phone, and sign with MD, DO, NP or PA.
The legal guardian checks the box acknowledging that the form may contain protected medical information and authorizing its sharing with the participant's school, coaches and relevant personnel. The guardian prints their name, signs and dates it, and lists emergency contacts. This acknowledgment is the consent the AAP says is needed before clinical PPE information goes to nonmedical school staff.
Download the current version from the source each time; forms change without notice.
Preparticipation Evaluation: Medical Eligibility Form
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.
Sources for this guide
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The signature line is for the evaluating health care professional with the credentials MD, DO, NP or PA. The clinician prints their name, adds the date, address and phone, and signs a statement that they examined the student, completed the evaluation and found no apparent clinical contraindications to the sports outlined on the form.
Only the Medical Eligibility Form. The AAP's PPE page and the form itself say it is the only PPE form that should be submitted to nonmedical personnel at a school or sports organization. The History and Physical Examination forms stay with the clinician, whose office keeps the examination findings available to the school at the parents' request.
It expands shared emergency information into a condition checklist, including sickle cell trait, POTS, heat stroke or rhabdomyolysis and stinger history, plus condition-specific activity guidelines for emergency medications and activity modifications. It adds an eligibility option for clearance after a named evaluation, and a legal guardian acknowledgment authorizing sharing with the school and coaches.
Yes. The attestation on page 2 states that if conditions arise after the athlete has been cleared, the physician may rescind medical eligibility until the problem is resolved and the potential consequences are completely explained to the athlete and to the parents or guardians.