GHSA By-Law 1.41 requires a certificate of an annual physical examination on file at the school before a student tries out, practices or plays, and member schools must use the AAP-approved evaluation form posted on the GHSA site. This four-page fillable form, revised March 9, 2023, holds the athlete's history, the physical exam and the medical eligibility decision that clears the student for sports.
The athlete completes and signs the two-page history before the appointment, with a parent or guardian if younger than 18. The examining clinician completes the physical examination form and the medical eligibility form, including the shared emergency information, and signs both pages.
The athlete enters first and last name, date of birth, date of examination, sports and sex assigned at birth, then lists past and current medical conditions, past surgeries, all prescription and over-the-counter medicines and supplements, and allergies to medicines, pollens, food or stinging insects. The form asks for this before the appointment, signed with a parent if the athlete is younger than 18.
Four items ask how often over the last two weeks the athlete felt nervous or on edge, could not stop worrying, had little interest in doing things, or felt down or hopeless, scored 0 to 3. The form notes that a sum of 3 or more on either pair of questions is considered positive for screening purposes.
Questions 1 to 3 cover concerns for the provider, past restrictions and ongoing issues. Questions 4 to 10 ask about passing out, chest discomfort, racing or irregular beats during exercise, known heart problems, prior heart tests, light-headedness and seizures. Questions 11 to 13 ask about family sudden death before 35, inherited conditions such as HCM, ARVC, long QT or Brugada syndrome, and family pacemakers or defibrillators before 35. Unknown answers are circled.
These cover stress fractures and injuries that caused missed practice, current joint problems, breathing trouble with exercise, missing organs, groin pain or hernia, recurring rashes including herpes or MRSA, concussion, numbness or weakness after a hit, heat illness, sickle cell trait or disease, vision problems, weight worries and eating disorders. Yes answers are explained in the space provided, and the athlete and parent sign and date the statement that the answers are complete and correct.
The reminders suggest more sensitive questions on stress, mood, home safety, tobacco and e-cigarettes, alcohol and drugs, anabolic steroids, weight or performance supplements, and seat belt, helmet and condom use. They also prompt the examiner to review the cardiovascular symptom questions, numbers 4 to 13 of the history form, before the hands-on exam.
Record height, weight, blood pressure, pulse and vision in each eye with or without correction. Mark each item normal or abnormal with findings: appearance including Marfan stigmata, eyes, ears, nose and throat with pupils and hearing, lymph nodes, heart with murmurs checked standing, supine and with Valsalva, lungs, abdomen, skin for HSV, MRSA-type lesions or tinea corporis, and neurological. A footnote says to consider ECG, echocardiography or cardiology referral for abnormal cardiac history or findings.
Mark the neck, back, shoulder and arm, elbow and forearm, wrist, hand and fingers, hip and thigh, knee, leg and ankle, and foot and toes as normal or abnormal with findings. The functional line covers the double-leg squat, single-leg squat and box drop or step drop tests. Print your name, date, address and phone, and sign as MD, DO, NP or PA.
Check one: eligible for all sports without restriction, eligible with recommendations for further evaluation or treatment of a stated issue, eligible for certain sports (list them), not eligible pending further evaluation, or not eligible for any sports. Add recommendations. The signed statement confirms there are no apparent clinical contraindications for the sports outlined, that exam findings are on file in the office, and that eligibility may be rescinded if new conditions arise. Sign with name, date, address and phone.
List the athlete's allergies, medications, other information relevant to emergencies, and emergency contacts. Because this block sits on the same page as the signed eligibility decision, school staff who read the clearance also see the details they would need if the athlete is hurt or becomes ill.
Download the current version from the source each time; forms change without notice.
Preparticipation Physical History and Evaluation Form
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Under By-Law 1.41, a physical is good for 12 months from the date of the exam. An exam taken on or after April 1 of the preceding year is accepted until the school finishes its classes or final spring sports season the next spring, so a late-spring physical can cover the entire following school year.
The exam may be conducted by a licensed medical physician, a doctor of osteopathic medicine, a nurse practitioner or a physician assistant. By-Law 1.41 requires the signature of an MD, DO or physician assistant, or of an advanced practice nurse who has been delegated that task by an MD or DO. The form's signature lines read MD, DO, NP or PA.
Yes. The GHSA forms page posts a fillable Spanish version of the Preparticipation Physical History and Evaluation Form, revised on the same date as the English one, March 9, 2023. The separate history for athletes with disabilities is listed in English only.
By-Law 1.41 requires GHSA member schools to use the edition of the preparticipation physical evaluation form approved by the American Academy of Pediatrics and its partner organizations, which is the version posted on the GHSA website. The school must have that certificate on file before the student tries out, practices, works out or plays.