Signature of Athlete Signature of Parent s or Guardian Date designed by MSHSAA Sports Medicine Advisory Committee 2011 PHYSICAL EXAMINATION FORM Physician Reminders Consider additional questions on more sensitive issues. Participants must obey all safety rules report all physical and hygiene problems to their coaches follow a proper conditioning program and inspect their own equipment daily. PARENTS GUARDIANS OR STUDENTS WHO MAY NOT WISH TO ACCEPT RISK DESCRIBED IN THIS WARNING SHOULD NOT SIGN THIS FORM. STUDENTS MAY NOT PARTICIPATE IN MSHSAA- SPONSORED SPORT WITHOUT THE STUDENT S AND PARENT S/GUARDIAN/S SIGNATURE. parent or guardian in the case of the student-athlete being a minor but that if necessary the student-athlete will be transported via ambulance to the nearest hospital. We hereby give our consent for the above student to represent his/her school in interscholastic athletics. HISTORY FORM PRE-PARTICIPATION PHYSICAL EVALUATION Note This form is to be filled out by the patient ....
Open form follow the instructions
Easily sign the form with your finger
Send filled & signed form or save
How to fill out the MO MSHSAA Pre-Participation Physical Evaluation online
Completing the MO MSHSAA Pre-Participation Physical Evaluation is an important step for student athletes to ensure their safety and readiness for participation in sports. This guide will provide you with a clear and supportive walkthrough of each section of the evaluation form, whether you are a user with minimal experience in filling out medical forms or someone looking to ensure compliance with health requirements.
Follow the steps to accurately complete your evaluation online.
- Press the ‘Get Form’ button to access the Pre-Participation Physical Evaluation form and open it in your preferred document editor.
- In the 'History Form' section, fill in the 'Date of Exam', 'Name', 'Date of Birth', 'Sex', 'Age', 'Grade', and 'School' fields. Make sure to accurately state your 'Sport(s)' participation as well.
- For the section on 'Medicines and Allergies', list all prescription and over-the-counter medications and supplements you are currently taking. Indicate whether you have any allergies and specify the type below if you answer 'Yes'.
- Proceed to the 'General Questions' segment. Carefully answer each question regarding your medical history, including any prior restrictions from sports or ongoing conditions.
- Contact the athlete's heart health by answering the heart health questions. Provide explanations for any 'Yes' answers at the designated space provided.
- Continue with the bone and joint questions, making sure to check any applicable injuries or conditions, and provide details for any that require further explanation.
- Fill in the medical questions section with accurate information about respiratory issues, past injuries, and overall health. Again, clarify any 'Yes' answers in the space given.
- For the female-specific questions, answer whether periods have been experienced and provide details about the menstrual cycle if applicable.
- Complete the 'Physical Examination Form' section with the physician after your examination, making sure to include height, weight, blood pressure, and other vital signs.
- After the examination, ensure the physician completes their information at the bottom of the evaluation form, including their signature and date.
- Finally, review the 'MSHSAA Eligibility and Authorization Statement’ section thoroughly. Both the student and parent or guardian must sign and date it to confirm their understanding and consent.
- Once all sections are complete, ensure to save all changes made, and consider downloading or printing the form for records. You may also share it as required.
Complete your MO MSHSAA Pre-Participation Physical Evaluation online today to ensure you meet your sport's requirement and stay safe during your athletic activities.
Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
Related content
Acts of violence shall include but not be limited to exertion of physical force by a...
A copy of the physical exam is on record in my office and can be made available to...
Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
If you believe that this page should be taken down, please follow our DMCA take down process here.
This form is available in several versions. Select the version you need from the drop-down list below.