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The New Jersey Department of Education Annual Athletic Pre-Participation Physical Examination Form is designed to ensure the health and safety of students participating in school athletic programs. It comprises two sections: Part A, a Health History Questionnaire completed by the student and parent and reviewed by the examining provider, and Part B, a Physical Evaluation Form completed by a licensed provider. This comprehensive assessment is crucial for identifying any potential health risks before participation in sports.

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Content Overview

Every athlete looking forward to participating in school sports in New Jersey encounters the Annual Athletic Pre-Participation Physical Examination Form, a vital step in ensuring their readiness and safety for the season ahead. This comprehensive form, mandated by the New Jersey Department of Education, is split into two major parts: Part A, the Health History Questionnaire, and Part B, the Physical Evaluation Form. Part A is a thorough inquiry into the student's medical history, filled out by the student and their parent or guardian, which covers everything from previous injuries and illnesses to medication allergies and family medical history. The aim here is to unearth any potential risk factors that could affect the student's ability to engage in sports activities safely. Part B, on the other hand, is conducted by a licensed medical provider—such as an MD, DO, APN, or PA—who performs a physical examination to assess the student's current health status, including their vision, cardiovascular health, and musculoskeletal condition. This part of the form also seeks to identify any signs of conditions like Marfan syndrome or issues that could predispose the student to sudden cardiac arrest. Beyond the core health assessment, the form delves into specific areas related to sports participation, such as concussion history, exercise-induced breathing issues, and even the psychological readiness of the student, ensuring a holistic view of the student's fitness for sports activities. This thorough evaluation not only helps in identifying any barriers to safe participation but also provides critical information that can aid in managing an athlete's health throughout the season, all while aligning with the New Jersey Administrative Code's programs to support student development.

Document Sample

New Jersey Department of Education

ANNUAL ATHLETIC PRE-PARTICIPATION PHYSICAL EXAMINATION FORM

Part A: HEALTH HISTORY QUESTIONNAIRE-Completed by the parent and student and reviewed by examining provider

Part B: PHYSICAL EVALUATION FORM-Completed by examining licensed provider with MD, DO, APN or PA

Part A: HEALTH HISTORY QUESTIONNAIRE

Today’s Date:_____________________	Date of Last Sports Physical: __________________________


Student’s Name: __________________________________ Sex: M F (circle one)		Age: ____	Grade: ________
Date of Birth: ____/___/_______	School: _____________________________	District: _______________________
Sport(s): _____________________________________________________________________		Home Phone: (_____) ___________

Provider Name (Medical Home): _______________________________ Phone: _______________________ Fax: ____________


	EMERGENCY CONTACT INFORMATION
Name of parent/guardian: _________________________________		Relationship to student: ______________________________
Phone (work): _____________________	Phone (home):______________________________		Phone (cell): ______________
Additional emergency contact: ____________________________		Relationship to student: ______________________________
Phone (work): _____________________	Phone (home):______________________________		Phone (cell): ______________

Directions: Please answer the following questions about the student’s medical history by CIRCLING the correct response. Explain all “yes” responses on the lines below the questions. Please respond to all questions.

1.Have you ever had, or do you currently have:

a. Restriction from sports for a health related problem?		Y / N / Don’t Know
b. An injury or illness since your last exam?		Y / N / Don’t Know
c. A chronic or ongoing illness (such as diabetes or asthma)?		Y / N / Don’t Know
(1.)	An inhaler or other prescription medicine to control asthma?	Y / N / Don’t Know
d. Any prescribed or over the counter medications that you take on a regular basis?		Y / N / Don’t Know
e. Surgery, hospitalization or any emergency room visit(s)?		Y / N / Don’t Know
f. Any allergies to medications?		Y / N / Don’t Know
g. Any allergies to bee stings, pollen, latex or foods?		Y / N / Don’t Know
(1.)	If yes, check type of reaction:
	□ Rash □ Hives □ Breathing or other anaphylactic reaction
(2.)	Take any medication/Epipen taken for allergy symptoms? (List below.)	Y / N / Don’t Know
h. Any anemias, blood disorders, sickle cell disease/trait, bleeding tendencies or clotting disorders? Y / N / Don’t Know
i. A blood relative who died before age 50?		Y / N / Don’t Know

Explain all “yes” answers here (include relevant dates):

List all medications here:

Medication Name	Dosage	Frequency

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2.Have you ever had, or do you currently have, any of the following head-related conditions:

a. Concussion or head injury (including “bell rung” or a “ding”)?	Y / N / Don’t Know
b. Memory loss?	Y / N / Don’t Know
c. Knocked out?	Y / N / Don’t Know
c. A seizure?	Y / N / Don’t Know
d. Frequent or severe headaches (With or without exercise)?	Y / N / Don’t Know
e. Fuzzy or blurry vision	Y / N / Don’t Know
f. Sensitivity to light/noise	Y / N / Don’t Know

Explain all “yes” answers here (include relevant dates):

____________________________________________________________________________________________________________

3.Have you ever had, or do you currently have, any of the following heart-related conditions:

a. Restriction from sports for heart problems?		Y / N / Don’t Know
b. Chest pain or discomfort?		Y / N / Don’t Know
c.	Heart murmur?	Y / N / Don’t Know
d.	High blood pressure?	Y / N / Don’t Know
e.	Elevated cholesterol level?	Y / N / Don’t Know
f.	Heart infection?	Y / N / Don’t Know
g.	Dizziness or passing out during or after exercise without known cause?	Y / N / Don’t Know

h.Has a provider ever ordered a heart test ( EKG, echocardiogram, stress test, Holter monitor)? Y / N / Don’t Know

i.	Racing or skipped heartbeats?	Y / N / Don’t Know
j.	Unexplained difficulty breathing or fatigue during exercise?	Y / N / Don’t Know

k.Any family member (blood relative):

(1.)	Under age 50 with a heart condition?	Y / N / Don’t Know
(2.)	With Marfan Syndrome?	Y / N / Don’t Know
(3.)	Died of a heart problem before age 50? If yes, at what age? _____________________	Y / N / Don’t Know
(4.)	Died with no known reason?	Y / N / Don’t Know
(5.)	Died while exercising? If yes, was it during or after? (Circle one.)	Y / N / Don’t Know

Explain all “yes” answers here (include relevant dates):

____________________________________________________________________________________________________________

4.Have you ever had, or do you currently have, any of the following eye, ear, nose, mouth or throat conditions:

a. Vision problems?	Y / N / Don’t Know
(1.) Wear contacts, eyeglasses or protective eye wear? (Circle which type.)	Y / N / Don’t Know
b. Hearing loss or problems?	Y / N / Don’t Know
(1.) Wear hearing aides or implants?	Y / N / Don’t Know
c. Nasal fractures or frequent nose bleeds?	Y / N / Don’t Know
d. Wear braces, retainer or protective mouth gear?	Y / N / Don’t Know
e. Frequent strep or any other conditions of the throat (e.g. tonsillitis)?	Y / N / Don’t Know

Explain all “yes” answers here (include relevant dates):

____________________________________________________________________________________________________________

5.Have you ever had, or do you currently have, any of the following neuromuscular/orthopedic conditions:

a. Numbness, a “burner”, “stinger” or pinched nerve?		Y / N / Don’t Know
b.	A sprain?	Y / N / Don’t Know
c.	A strain?	Y / N / Don’t Know
d.	Swelling or pain in muscles, tendons, bones or joints?	Y / N / Don’t Know
e.	Dislocated joint(s)?	Y / N / Don’t Know
f.	Upper or lower back pain?	Y / N / Don’t Know
g.	Fracture(s), stress fracture(s), or broken bone(s)?	Y / N / Don’t Know
h.	Do you wear any protective braces or equipment?	Y / N / Don’t Know

Explain all (yes) answers here (include relevant dates):

____________________________________________________________________________________________________________

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6.Have you ever had or do you currently have any of the following general or exercise related conditions: a. Difficulty breathing?

(1.)	During exercise?	Y / N / Don’t Know
(2.)	After running one mile?	Y / N / Don’t Know
(3.)	Coughing, wheezing or shortness of breath in weather changes?	Y / N / Don’t Know
(4.)	Exercise-induced asthma?	Y / N / Don’t Know
	i. Controlled with medication? (specify __________________________)	Y / N / Don’t Know
	ii. Experience dizziness, passing out or fainting?	Y / N / Don’t Know
b. Viral infections (e.g. mono, hepatitis, coxsackie virus)?		Y / N / Don’t Know
c. Become tired more quickly than others?		Y / N / Don’t Know
d. Any of the following skin conditions:
(1.)	Cold sores/herpes, impetigo, MRSA, ringworm, warts?	Y / N / Don’t Know
(2.)	Sun sensitivity?	Y / N / Don’t Know
e. Weight gain/loss (of 10 pounds or more)?		Y / N / Don’t Know
(1.)	Do you want to weigh more or less than you do now?	Y / N / Don’t Know
f. Ever had feelings of depression?		Y / N / Don’t Know
g. Heat-related problems (dehydration, dizziness, fatigue, headache)?		Y / N / Don’t Know
(1.)	Heat exhaustion (cool, clammy, damp skin)?	Y / N / Don’t Know
(2.)	Heat stroke (hot, red, dry skin)?	Y / N / Don’t Know
(3.)	Muscle cramps?	Y / N / Don’t Know
h. Absence or loss of an organ (e.g. kidney, eyeball, spleen, testicle, ovary)?		Y / N / Don’t Know

Explain all “yes” answers here (include relevant dates):

__________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

7.	Females only:
	Age of onset of menstruation:______	How many menstrual periods in the last twelve (12) months?		________
		How many periods missed in the last twelve (12) months?		________
8.	Males only:
	Have you had any swelling or pain in your testicles or groin?		Y / N / Don’t Know

PARENT/GUARDIAN SIGNATURE

I certify that the information provided herein is accurate to the best of my knowledge as of the date of my signature.

_______________________________________	_________________
Signature, Parent/Guardian or Student Age 18	Date of Signature:

THIS COMPLETED AND SIGNED HEALTH HISTORY MUST BE REVIEWED BY THE

EXAMINING PROVIDER AT THE TIME OF THE MEDICAL EXAM.

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ANNUAL ATHLETIC PRE-PARTICIPATION PHYSICAL EVALUATION FORM

Part B: Physical Evaluation Form

(Completed by the examining licensed provider MD, DO, APN or PA)

-STUDENT INFORMATION-

Student’s Name: __________________________________ Sport(s): _____________________________________________________

Sex: M F (circle one) Age: ________ Grade: _____________

Date of Birth: _________________________________________

Address: ___________________________________________________________________________________________________________

City/State/Zip:________________________________________________	Home Phone: _________________________________________
School: _____________________________________________________	District: _____________________________________________

Parent/Guardian’s Full Name: __________________________________________________________________________________________

- EXAMINING PHYSICIAN/PROVIDER CONTACT INFORMATION-

If conducted by school physician check here □
Name: _______________________________			Phone: __________________________			Fax: _________________
Address:______________________________			City/State/Zip:_____________________________________________


		- FINDINGS OF PHYSICAL EVALUATION -
Height: _________	Weight: _________		Blood Pressure: ______/_______ Pulse: _____bpm.
Vision: R 20/____ L 20/ ____		Corrected: Y / N	Contacts: Y / N		Glasses: Y / N

INDICATORS		NORMAL?	ABNORMAL FINDINGS/COMMENTS

General Appearance		YES
Head/Neck		YES
Eyes/Sclera/Pupils		YES
Ears		YES
Gross Hearing		YES
Nose/Mouth/Throat		YES
Lymph Glands		YES
Cardiovascular		YES
Heart Rate		YES
Rhythm		YES
Murmur		ABSENT
If murmur present			Standing makes it:	Louder	Softer	No Change
			Squatting makes it:	Louder	Softer	No Change
			Valsalva makes it:	Louder	Softer	No Change
Femoral Pulses		YES
Lungs: Auscultation/Percussion		YES
Chest Contour		YES
Skin		YES
Abdomen (liver, spleen, masses)		YES
Assessment of physical maturation or		YES
Tanner Scale
Testicular Exam (Males Only)		YES
Neck/Back/Spine:		YES

Range of Motion		YES

Scoliosis		ABSENT

Upper Extremities: (ROM, Strength,		YES
Stability)
Lower Extremities: (ROM, Strength,		YES
Stability)
Neurological: Balance & Coordination		YES
Hernia		ABSENT
Evidence of Marfan Syndrome		ABSENT
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Most recent immunizations and dates administered:

____________________________________________________________________________________________________________

Medications currently prescribed, with dose and frequency:

Medication Name

Dosage

Frequency

Additional observations:

________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

General Diagnosis: ____________________________________________________________________________________________

____________________________________________________________________________________________________________

___________________________________________________________________________________________________________

General Recommendations:

____________________________________________________________________________________________________________

___________________________________________________________________________________________________________

THE HISTORY PREPARED BY THE PARENT/STUDENT MUST BE REVIEWED BY THE EXAMINING PROVIDER AT THE TIME OF THE PHYSICAL EXAMINATION.

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CLEARANCES: This section is completed by the examining healthcare provider.

After examining the student and reviewing the medical history the student is:

⁪

A.Cleared for participation in all sports without restrictions.

B.Not cleared for participation in any sport until evaluation/treatment of:

___________________________________________________________________________________

C.Cleared for limited participation in the following types of sports only. Please see below for sport classifications. CHECK ALL THAT APPLY

___	CONTACT/COLLISION	___	NON-CONTACT/STRENUOUS
___	LIMITED CONTACT	___	NON-CONTACT/NON-STRENUOUS

Limitations due to: ___________________________________________________________________

________________________________________________

NOTES TO THE EXAMINING PROVIDER

Conditions requiring clearance before sports participation include, but are not limited to the following:

Anaphylaxis; Atlantoaxial instability; Bleeding disorder; Hypertension; Congenital heart disease; Dysrhythmia; Mitral valve prolapse; Heart murmur; Cerebral palsy; Diabetes mellitus; Eating disorders; Heat illness history; One-kidney athletes; Hepatomegaly, Splenomegaly; Malignancy; Seizure Disorder; Marfan’s Syndrome; History of repeated concussion; Organ transplant recipient; Cystic fibrosis; Sickle cell disease; and/or One-eyed athletes or athletes with vision greater than 20/40 in one eye.

SAMPLES OF CLASSIFICATION OF SPORTS BY CONTACT

Contact/Collision	Limited Contact	Non-Contact
		Strenuous	Non-strenuous
Basketball	Baseball	Discus	Bowling
Diving	Cheerleading	Javelin	Golf
Field Hockey	Fencing	Shot put
Football	High Jump	Rowing
Ice Hockey	Pole vault	Running/Cross Country
Lacrosse	Gymnastics	Strength Training
Soccer	Skiing	Swimming
Wrestling	Softball	Tennis
	Volleyball	Track

Effects of physiologic maneuvers on heart sounds			Physical Stigmata of Marfan’s Syndrome
Standing		Increases murmur of HCM	Kyphosis
		Decreases murmur of AS, MR	High arched palate
		MVP click occurs earlier in systole	Pectus excavatum
			Arachnodactyly
Squatting		Increases murmur of AS, MR, AI	Arm span > height 1.05:1 or greater
		Decreases murmur of MCH	Mitral Valve Prolapse
		MVP click delayed	Aortic Insufficiency
			Myopia
Valsalva		Increases murmur of HCM	Lenticular dislocation
		Decreases murmur of AS, MR
		MVP click occurs earlier in systole
HCM:	Hypertrophic Cardio Myopathy
AS:	Aortic Stenosis
AI:	Aortic Insufficiency
MR:	Mitral Regugitation
MVP:	Mitral Valve Prolapse

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______________________

Date

HISTORY REVIEWED AND STUDENT EXAMINED BY:

Physician’s/Provider’s Stamp:

฀Primary Care Provider

฀School Physician Provider

฀License Type:

฀MD/DO

฀APN

฀PA

PHYSICIAN’S/PROVIDER’S SIGNATURE: __________________________________________________

Today’s Date: ______________

Date of Exam: ______________

RESERVED FOR SCHOOL DISTRICT USE

NOTE: N.J.A.C. 6A:16-2.2 requires the school physician to provide written notification to the parent/legal guardian stating approval or disapproval of the student’s participation in athletics based on this physical evaluation. This evaluation and the notification letter become part of the student’s school health record.


History and Physical Reviewed By:	__________________________________		Date: _______________
Title of Reviewer (please check one):	฀ School Nurse	฀ School Physician

Medical Eligibility Notification Sent to Parent/Guardian by School Physician

฀Letter of notification is attached.

Parent notification indicates that:

฀Participation Approved without limitations.

฀Participation Approved with limitations pending evaluation.

฀Participation NOT Approved

Reason(s) for Disapproval: ____________________________________________________________

_____________________________________________________________________________________

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Use of this form is required by N.J.A.C. 6A:16-Programs to Support Student Development

↓ Nj Sports Phisical PDF Form

Form Attributes

Fact	Detail
Form Revision Date	March 2010
Governing Law	N.J.A.C. 6A:16 - Programs to Support Student Development
Form Parts	Part A: Health History Questionnaire, Part B: Physical Evaluation Form
Part A Completion	Completed by the parent and student, reviewed by the examining provider
Part B Completion	Completed by an examining licensed provider with MD, DO, APN, or PA credentials
Medical History Questions	Includes history of illnesses, allergies, medications, and previous injuries or surgeries
Physical Examination Findings	Covers general appearance, cardiovascular system, musculoskeletal system, and other physical aspects
Immunizations and Medications	Includes the most recent immunizations and current prescribed medications
Emergency Contact Information	Requires listing of primary and additional emergency contacts
Parent/Guardian Verification	Requires the signature of a parent/guardian or the student if they are 18 years of age or older

Nj Sports Phisical: Usage Guide

Filling out the New Jersey Sports Physical Form is a crucial step for student-athletes participating in sports, ensuring they are healthy and ready for the physical demands of their activities. This form consists of two main parts: Part A, the Health History Questionnaire, which must be completed by the parent and student, and Part B, the Physical Evaluation Form, to be filled out by a licensed medical provider. Let’s walk through the steps needed to complete Part A, as this part is typically filled out before seeing a healthcare provider.

Start by entering today’s date and the date of the student’s last sports physical at the top of Part A.
Fill in the student’s name, circle the correct sex, and provide the student's age, grade, date of birth, school name, and district.
List the sport(s) the student plans to participate in within the designated area.
Provide a home phone number, as well as the name, phone, and fax number of the student's primary medical provider.
For emergency contact information, write down the name, relationship to the student, and home, work, and cell phone numbers for the primary and an additional emergency contact.
Answer all health history questions in the questionnaire section, circling "Y" for yes, "N" for no, or "Don’t Know" as applicable. If you circle "Y" for any question, make sure to explain your answer in the provided space below each group of questions.
List all medications the student is currently taking, including the medication name, dosage, and frequency of intake.
For female students, fill in the age of onset of menstruation, the number of menstrual periods in the last twelve months, and how many periods have been missed in that same period.
Male students need to answer whether they have had any swelling or pain in their testicles or groin.
Have the parent or guardian sign the form, verifying that all information provided is accurate to the best of their knowledge. Include the date of the signature.

Once Part A is completed thoroughly and signed, it should be brought along to the medical exam, where the healthcare provider will review the health history and complete Part B, the Physical Evaluation. Remember, this form not only helps to catch potential health issues before they become serious but also supports the safety and well-being of student-athletes as they engage in sports.

Listed Questions and Answers

NJ Sports Physical Form FAQ

What is the purpose of the New Jersey Sports Physical Form?

This form is essential for assessing the overall health and physical condition of students planning to participate in athletic activities. Part A collects comprehensive health history from the student and their parents, which is reviewed by a medical provider. Part B involves a physical examination conducted by a licensed medical professional. This thorough review ensures the student's readiness and safety for sports participation, adhering to the New Jersey Department of Education requirements.

Who is required to complete this form?

All students in New Jersey who wish to take part in school sports activities must have this form completed. Part A must be filled out by the student and their parent or guardian, providing detailed health history information. Part B is exclusively for a licensed healthcare provider (MD, DO, APN, or PA) to complete, based on their physical examination findings of the student.

How often does the NJ Sports Physical Form need to be updated or completed?

The form must be updated and submitted annually. This ensures that the medical information is current and reflective of the student's most recent health status, allowing for safe participation in athletic programs. It is crucial also to update the form if there are any significant changes in the student's health during the year.

What should I do if I answer 'Yes' to any of the questions on the Health History Questionnaire (Part A)?

Provide detailed explanations for each "Yes" response, including dates and specifics of the condition or event. This information is critical for the medical provider reviewing the form.
Discuss these health concerns with the licensed provider during the physical examination. They may require additional information or recommend further evaluation.
Ensure all medications, including dosage and frequency, are accurately listed. This includes both prescribed and over-the-counter medications.

What happens after the Physical Examination Form (Part B) is completed?

Once Part B is filled out by the examining licensed provider, it, along with the completed Health History Questionnaire (Part A), should be submitted to the designated school authority, usually the school nurse or athletic department. The school will review the forms to ensure compliance with the New Jersey Department of Education’s guidelines for athletic participation. If the medical provider identifies any concerns during the examination that might affect the student's ability to participate safely in sports, those will need to be addressed according to the guidelines provided in the form.

Common mistakes

When completing the New Jersey Department of Education's Annual Athletic Pre-Participation Physical Examination Form, common mistakes can occur that may affect the accuracy and completeness of the health information provided. Below are ten common mistakes:

Failing to fill out today's date and the date of the last sports physical, which are critical in tracking the timing and frequency of health evaluations.
Omitting the student's date of birth, which is essential for age verification and ensuring appropriate health screenings for the student's age group.
Not specifying the sport(s) the student intends to participate in, leading to a lack of tailored advice based on the physical demands of specific sports.
Incomplete emergency contact information, including only one contact number or lacking an additional emergency contact, can delay reaching a guardian in an urgent situation.
Circling 'Don’t Know' instead of 'Yes' or 'No' to health history questions without providing an explanation, which leaves health providers without crucial information that could influence the student's care.
Leaving the medication list blank or incomplete, not detailing the names, dosages, and frequency of medications currently taken, both prescribed and over-the-counter.
Not thoroughly explaining “yes” responses in the health history section, including failing to provide dates and details of past medical events, such as surgeries or hospitalizations.
Skipping questions related to familial health history that are vital for identifying potential inherited conditions, such as heart problems or Marfan Syndrome.
Incorrect or missing information regarding the student's vision and hearing status, including whether they wear glasses, contacts, or hearing aids, which might affect their safety during sports activities.
Parent/Guardian signature and date of signature missing, an oversight that renders the form incomplete and not legally validated.

To avoid these mistakes, it is recommended that the form be reviewed carefully and completed with attention to detail, ensuring that all required fields are filled accurately and completely. This diligence helps in safeguarding the health and safety of student-athletes, allowing for a more informed and personalized care plan.

Documents used along the form

Completing the New Jersey Department of Education Annual Athletic Pre-Participation Physical Examination Form is an important step in preparing students for participation in school sports. Besides this essential form, other documents and forms are often used to ensure a comprehensive assessment of a student's health and fitness for athletic activities. Below is a list and descriptions of these documents.

Immunization Record: This document provides a history of all the vaccinations a student has received. Schools and sports organizations often require up-to-date immunization records to protect the health and safety of all participants.
Concussion Acknowledgment Form: This form is used to educate parents and students about concussions. It includes information on recognizing the signs and symptoms of concussions, the risks associated with continuing to play after a concussion is suspected, and the necessary steps to take if a concussion is suspected.
Emergency Contact Information: Although part of the physical examination form includes basic contact information, a more detailed emergency contact form may be required. This ensures the school or organization has all necessary details to contact parents, guardians, or other emergency contacts in case of an incident.
Health Insurance Information: This document details the student's health insurance coverage. Schools and organizations use this information to manage any medical treatment costs that may arise from participation in sports activities.
Asthma Action Plan: For students with asthma, an Asthma Action Plan is crucial. This document, typically prepared by the student's healthcare provider, outlines the student's triggers, symptoms, medication, and steps to take in case of an asthma attack.
Medication Authorization Form: This form is required for students who need to take medication during school hours or sports activities. It must be completed and signed by the student's healthcare provider and parent/guardian, detailing the medication, dosage, and administration instructions.

Together with the New Jersey Department of Education Annual Athletic Pre-Participation Physical Examination Form, these documents ensure a holistic approach to a student's health and safety in sports. By addressing various aspects of health, from chronic conditions like asthma to emergency planning, schools and sports organizations help create a safe environment for young athletes to thrive in their chosen sports activities.

Similar forms

The New Jersey Sports Physical Form shares similarities with the generic Physical Examination Form often utilized in various healthcare settings. Both documents are structured to capture comprehensive health information essential for determining an individual’s fitness for specific activities. The Physical Examination Form, like the NJ Sports Physical Form, consists of two main parts: a health history questionnaire and a physical evaluation section. While the sports physical is tailored towards assessing the ability to participate in sports safely, the generic physical examination form serves a broader purpose, evaluating overall health status. Each form includes sections on medical history, medication usage, allergies, and family medical history, ensuring a thorough review of factors that could influence the individual’s health during physical activities or generally.

Another document resembling the NJ Sports Physical Form is the Pre-employment Physical Examination Form. Employers often require this assessment to ensure potential employees are physically capable of performing their job duties safely. Both forms share the objective of assessing the physical condition and health history of the individual to ascertain their fitness for a specific role – whether it be athletic participation or job performance. The employment physical might focus more on the specific physical demands of the job, while the sports physical is more concerned with the general ability to participate in sports. Nonetheless, both entail detailed questions about past medical history, current health status, and a physical examination to identify any limitations or conditions that need to be managed.

The School Entry Health Examination Form is another document with features similar to the NJ Sports Physical Form. This form is required for enrollment in many schools and focuses on ensuring that students are in good health and up-to-date with immunizations. Like the sports physical form, it includes sections for health history and a physical examination but places additional emphasis on immunization records and developmental health. Both forms play a crucial role in safeguarding the health of students by identifying and addressing health issues that could affect participation in school activities, including sports, thereby ensuring a safe and conducive learning environment.

Finally, the Camp Medical Form, required for participation in many summer and sports camps, bears resemblance to the NJ Sports Physical Form. It is designed to inform camp staff about a camper's medical history, current medications, and any special health care needs or accommodations that may be necessary. Both documents necessitate detailed health histories and evaluations to ensure the safety of participants in physically demanding activities. These forms are preventative measures that enable responsible adults to anticipate and manage potential health issues in non-clinical environments, ensuring that all activities are conducted within safe boundaries for each individual’s health status.

Dos and Don'ts

Filling out the New Jersey Sports Physical Form requires attention to detail and completeness to ensure the health and safety of student-athletes. Here are some guidelines on what you should and shouldn't do when completing this form.

What You Should Do:

Ensure accuracy: Double-check all information you provide, especially the medical history details. Accurate information helps medical providers offer the best care and make informed decisions about the student's ability to participate in sports.
Complete every section: Do not leave any section blank unless it's specifically not applicable to the student. If a question is not applicable, consider marking it as "N/A" to indicate it was reviewed but not skipped.
Provide detailed explanations: For any "yes" responses in the health history section, offer detailed explanations including relevant dates and outcomes. This helps the evaluating provider understand the context and severity of past medical issues.
Review for updates: Before the physical exam, review the form with the student for any changes in their health status or medication since the last update. This ensures the most current information is available during the evaluation.

What You Shouldn't Do:

Guess on medical history: Avoid guessing or assuming details about the student's medical history. If you're unsure about a past event or condition, it's better to verify with previous medical records or consult with a healthcare provider before answering.
Overlook the medication list: Do not forget to list all medications the student is currently taking, including over-the-counter drugs and supplements. This information is crucial for assessing any potential health risks associated with sports participation.
Ignore the importance of emergency contact information: Do not underestimate the importance of providing up-to-date emergency contact information. This ensures that parents or guardians can be quickly contacted in case of an emergency.
Delay submission: Avoid waiting until the last minute to submit the completed form. Early submission allows time for any necessary follow-up or additional medical evaluations before the sports season begins.

Misconceptions

Understanding the New Jersey Sports Physical Form can often come with misconceptions that may cause confusion for students, parents, and guardians. It's essential to clarify these misunderstandings to ensure the health and safety of student-athletes. Here are eight common misconceptions about the NJ Sports Physical Form and their explanations:

Only the physical exam is important. Many believe the physical examination (Part B) is the only critical component of the form, overlooking the health history questionnaire (Part A). Part A is equally vital as it provides a comprehensive medical history that aids in assessing the student's overall health and readiness for participation in sports.
Any healthcare provider can complete the form. The physical evaluation form must be completed by a licensed provider with specific qualifications: MD (Doctor of Medicine), DO (Doctor of Osteopathy), APN (Advanced Practice Nurse), or PA (Physician Assistant). This ensures that the evaluation meets the standards required by the New Jersey Department of Education.
The form is valid for any length of time. The NJ Sports Physical Form is only valid for 365 days from the date of the examination. Students must ensure their physicals are current for the entirety of their sports season, requiring timely planning for examination appointments.
All sections of the form apply to every student. Certain sections of the form target specific demographics, such as "Females only" and "Males only," ensuring relevant health information is gathered according to gender-specific health concerns.
Emergency contact information is optional. The emergency contact information is a critical component of the health history questionnaire. It ensures that a parent, guardian, or alternate contact can be reached promptly in the event of an emergency during sports participation.
Signing the form isn't necessary. The signature of a parent/guardian or the student (if 18 years of age) at the end of Part A (Health History Questionnaire) asserts that the information provided is accurate. This step is mandatory, affirming the veracity of the medical history shared.
A student can participate in sports before the form is reviewed. The completed health history must be reviewed by the examining provider at the time of the medical examination. This ensures that the medical professional is fully informed of the student's health history before clearing them for sports participation.
Health recommendations are advisories, not mandates. General recommendations provided at the end of Part B following the physical evaluation may include necessary actions or restrictions to ensure the student's health and safety during athletic participation. These recommendations should be taken seriously and followed to protect student-athletes from potential health risks.

Clarifying these misconceptions ensures that students, parents, and guardians are well-informed about the sports physical process, promoting a safe environment for student-athletes in New Jersey.

Key takeaways

Filling out the New Jersey Sports Physical Form, officially known as the Annual Athletic Pre-Participation Physical Examination Form, is a crucial step in ensuring the safety and readiness of student-athletes for participation in sports. Here are 10 key takeaways to help guide students, parents, and guardians through this process:

Complete the Health History Questionnaire (Part A) thoroughly. This part must be filled out by the parent and the student. It provides valuable information about the student's medical history, which is essential for the examining provider.
Ensure that all questions on the Health History Questionnaire are answered. If "yes" is the answer, you must provide an explanation, including relevant dates. This helps the examiner understand the context and significance of each health issue.
Be prepared to list all medications, including dosage and frequency, that the student is currently taking. This includes both prescribed medications and over-the-counter drugs.
Update emergency contact information accurately. This information is crucial in case of an emergency during sports participation.
The Physical Examination Form (Part B) must be completed by a licensed provider such as an MD, DO, APN, or PA. This ensures that the student-athlete has been examined by a qualified professional who can attest to their physical condition.
Understand that the physical evaluation includes assessments beyond a basic checkup, covering areas such as vision, hearing, cardiovascular health, and musculoskeletal stability.
Be aware of the guidelines regarding heart health questions, especially for students with a family history of heart conditions. This part of the assessment is critical for detecting potential risks associated with sports participation.
The form requires information on the most recent immunizations and any current medications, reflecting the importance of vaccine-preventable diseases and the impact of medications on physical activity.
The signature of a parent/guardian (or the student, if 18 years of age or older) is mandatory to certify the accuracy of the information provided in the Health History Questionnaire.
Finally, remember the significance of this form's role in the overall safety and well-being of student-athletes. It's not just a formality; it's a comprehensive review designed to ensure that students are healthy and physically prepared to take part in sports activities.

Taking the time to accurately complete the New Jersey Sports Physical Form can help prevent sports-related injuries and ensure a safe and enjoyable athletic experience for all students.

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