The FHSAA EL2 Form is a crucial document for high school athletes in Florida, acting as a Preparticipation Physical Evaluation to ensure the safety and readiness of participants for athletic activities. This comprehensive form, which must be filled out and submitted to the school, remains valid for 365 calendar days from the evaluation date indicated on the form. Changes in schools within this period necessitate the resubmission of the first page of the document. For all student-athletes looking to compete in Florida high school sports, completing this form accurately and timely is a step you cannot skip.
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The FHSAA EL2 form, also known as the Florida High School Athletic Association Preparticipation Physical Evaluation, plays a pivotal role in ensuring the health and safety of student-athletes before they engage in school sports programs. Revised in March 2016, this comprehensive document spans three pages, each serving a distinct purpose in the preparticipation evaluation process. The form's validity extends for a full 365 calendar days from the date of the medical evaluation indicated on page 2, underscoring its temporal relevance for sports participation within that timeframe. It is meticulously structured to capture crucial student information, medical history, and the results of physical examinations. Notably, the form emphasizes the non-transferable nature of the evaluation, requiring resubmission if a student changes schools during its validity period. This requirement highlights the tailored approach of the evaluation process to individual student health and activity readiness. Moreover, the form serves as a reminder for students and parents about the importance of undergoing cardiovascular assessments beyond routine checks, given the potential for undiscovered issues that could affect a student’s well-being. These characteristics of the FHSAA EL2 form underline the association’s commitment to the preemptive identification of health concerns that could impede a student’s safe participation in school sports activities.
EL2
Florida High School Athletic Association
Preparticipation Physical Evaluation (Page 1 of 3)
REVISED 03/16
This completed form must be kept on ile by the school. This form is valid for 365 calendar days from the date of the evaluation as written on page 2.
This form is non-transferable; a change of schools during the validity period of this form will require page 1 of this form to be re-submitted.
Part 1. Student Information (to be completed by student or parent)
Student’s Name: ________________________________________________________________________ Sex: _____ Age: _____ Date of Birth: _____/ _____/ _____
School: ____________________________________________________ Grade in School: _____ Sport(s): ________________________________________________
Home Address: _______________________________________________________________________________________ Home Phone: ( _____) _______________
Name of Parent/Guardian: _______________________________________________________________ E-mail: ___________________________________________
Person to Contact in Case of Emergency: _____________________________________________________________________________________________________
Relationship to Student: _______________________ Home Phone: ( _____) ______________ Work Phone: ( _____) _____________ Cell Phone: ( _____) _____________
Personal/Family Physician: ___________________________________________City/State: ___________________________ Ofice Phone: ( _____) _____________
Part 2. Medical History (to be completed by student or parent). Explain “yes” answers below. Circle questions you don’t know answers to.
Yes
No
1.
Have you had a medical illness or injury since your last
____
check up or sports physical?
2.
Do you have an ongoing chronic illness?
3.
Have you ever been hospitalized overnight?
4.
Have you ever had surgery?
5.
Are you currently taking any prescription or non-
prescription (over-the-counter) medications or pills or
using an inhaler?
6.
Have you ever taken any supplements or vitamins to
help you gain or lose weight or improve your
performance?
7.
Do you have any allergies (for example, pollen, latex,
medicine, food or stinging insects)?
8.
Have you ever had a rash or hives develop during or
after exercise?
9.
Have you ever passed out during or after exercise?
10.
Have you ever been dizzy during or after exercise?
11.
Have you ever had chest pain during or after exercise?
12.
Do you get tired more quickly than your friends do
during exercise?
13.
Have you ever had racing of your heart or skipped
heartbeats?
14.
Have you had high blood pressure or high cholesterol?
15.
Have you ever been told you have a heart murmur?
16.
Has any family member or relative died of heart
problems or sudden death before age 50?
17.
Have you had a severe viral infection (for example,
myocarditis or mononucleosis) within the last month?
18.
Has a physician ever denied or restricted your
participation in sports for any heart problems?
19.
Do you have any current skin problems (for example,
itching, rashes, acne, warts, fungus, blisters or pressure sores)?
20.
Have you ever had a head injury or concussion?
21.
Have you ever been knocked out, become unconscious
or lost your memory?
22.
Have you ever had a seizure?
23.
Do you have frequent or severe headaches?
24.
Have you ever had numbness or tingling in your arms,
hands, legs or feet?
25. Have you ever had a stinger, burner or pinched nerve?
26.
Have you ever become ill from exercising in the heat?
27.
Do you cough, wheeze or have trouble breathing during or after
activity?
28.
Do you have asthma?
29.
Do you have seasonal allergies that require medical treatment?
30.
Do you use any special protective or corrective equipment or
medical devices that aren’t usually used for your sport or position
(for example, knee brace, special neck roll, foot orthotics, shunt,
retainer on your teeth or hearing aid)?
31.
Have you had any problems with your eyes or vision?
32.
Do you wear glasses, contacts or protective eyewear?
33.
Have you ever had a sprain, strain or swelling after injury?
34.
Have you broken or fractured any bones or dislocated any joints?
35.
Have you had any other problems with pain or swelling in muscles,
tendons, bones or joints?
If yes, check appropriate blank and explain below:
___ Head
___ Elbow
___ Hip
___ Neck
___ Forearm
___ Thigh
___ Back
___ Wrist
___ Knee
___ Chest
___ Hand
___ Shin/Calf
___ Shoulder
___ Finger
___ Ankle
___ Upper Arm
___ Foot
36.
Do you want to weigh more or less than you do now?
37.
Do you lose weight regularly to meet weight requirements for your
sport?
38.
Do you feel stressed out?
39.
Have you ever been diagnosed with sickle cell anemia?
40.
Have you ever been diagnosed with having the sickle cell trait?
41.
Record the dates of your most recent immunizations (shots) for:
Tetanus: _______________
Measles: _______________
Hepatitus B: ____________
Chickenpox: ____________
FEMALES ONLY (optional)
42.When was your irst menstrual period? _______________________
43.When was your most recent menstrual period? _________________
44.How much time do you usually have from the start of one period to the start of another?_______________________________________
45.How many periods have you had in the last year? _______________
46.What was the longest time between periods in the last year? ________
Explain “Yes” answers here:_______________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________
We hereby state, to the best of our knowledge, that our answers to the above questions are complete and correct. In addition to the routine medical evaluation required by s.1006.20, Florida Statutes, and FHSAA Bylaw 9.7, we understand and acknowledge that we are hereby advised that the student should undergo a cardiovascular assessment, which may include such diagnostic tests as electrocardiogram (EKG), echocardiogram (ECG) and/or cardio stress test.
Signature of Student: _____________________________________ Date: ____/ ____/ ____ Signature of Parent/Guardian: __________________________________ Date: ____/ ____/ ____
– 1 –
Preparticipation Physical Evaluation (Page 2 of 3)
Part 3. Physical Examination (to be completed by licensed physician, licensed osteopathic physician, licensed chiropractic physi- cian, licensed physician assistant or certiied advanced registered nurse practitioner).
Student’s Name: _____________________________________________________________________________________________ Date of Birth: _____/_____/_____
Height: _____________ Weight: _____________ % Body Fat (optional): ____________ Pulse: _________ Blood Pressure: ____ / ____ ( ____/____ , ____ /____ )
Temperature: _____________ Hearing: right: P ______ F _____ left: P _____ F _____
Visual Acuity: Right 20/_______
Left 20/_______
Corrected: Yes
Pupils: Equal _________ Unequal _________
FINDINGS
NORMAL
ABNORMAL FINDINGS
INITIALS*
MEDICAL
Appearance
________
________________________________________________________________________
____________
Eyes/Ears/Nose/Throat
Lymph Nodes
Heart
Pulses
Lungs
Abdomen
Genitalia (males only)
Skin
MUSCULOSKELETAL
Neck
Back
Shoulder/Arm
Elbow/Forearm
Wrist/Hand
Hip/Thigh
Knee
Leg/Ankle
Foot
* – station-based examination only
ASSESSMENT OF EXAMINING PHYSICIAN/PHYSICIAN ASSISTANT/NURSE PRACTITIONER
I hereby certify that each examination listed above was performed by myself or an individual under my direct supervision with the following conclusion(s):
____ Cleared without limitation
____ Disability: _____________________________________________________ Diagnosis: ___________________________________________________________
_______________________________________________________________________________________________________________________________________
____ Precautions: ________________________________________________________________________________________________________________________
____ Not cleared for: __________________________________________________________________________ Reason: ___________________________________
____ Cleared after completing evaluation/rehabilitation for: ______________________________________________________________________________________
____ Referred to ______________________________________________________________________________ For: ______________________________________
Recommendations: _______________________________________________________________________________________________________________________
Name of Physician/Physician Assistant/Nurse Practitioner (print): __________________________________________________________ Date: _____/_____/_______
Address: _______________________________________________________________________________________________________________________________
Signature of Physician/Physician Assistant/Nurse Practitioner: ____________________________________________________________________________________
– 2 –
Preparticipation Physical Evaluation (Page 3 of 3)
Student’s Name: _____________________________________________________________________________________________
ASSESSMENT OF PHYSICIAN TO WHOM REFERRED (if applicable)
I hereby certify that the examination(s) for which referred was/were performed by myself or an individual under my direct supervision with the following conclusion(s):
Name of Physician (print): ___________________________________________________________________________________________ Date: ____/____/_______
Signature of Physician: ___________________________________________________________________________________________________________________
Based on recommendations developed by the American Academy of Family Physicians, American Academy of Pediatrics, American Medical Society for Sports Medicine, American Orthopae- dic Society for Sports Medicine and American Osteopathic Academy for Sports Medicine.
– 3 –
Filling out the FHSAA EL2 Form is a necessary step for student athletes who wish to participate in school sports. This process involves providing accurate health information and obtaining a physical evaluation from a qualified healthcare professional. Once completed, the form ensures eligibility for sports involvement for one year from the date of the physician's signature. Here’s how to properly complete the form:
Once all parts are filled out, submit the form as directed by the school or sports organization. Retain a copy for your records. The completion of this form is just the first step in ensuring a safe and healthy sports season. Always consult sports or school officials for further instructions or if additional documentation is required.
The FHSAA EL2 form, known as the Preparticipation Physical Evaluation, is designed to ensure that students are medically fit to participate in high school sports activities. It helps in identifying any health concerns that could interfere with a student’s athletic performance or increase their risk of injury during sports participation. This form must be completed and on file at the school before the student can engage in any sports activities.
This form is valid for 365 calendar days from the date of the physical evaluation as noted on page 2 of the form. It implies that students must undergo a new evaluation and submit a new EL2 form each year to continue participating in school sports activities.
No, the EL2 form is not transferable between schools. If a student changes schools during the validity period of the form, page 1 of the EL2 form must be re-submitted at the new school. This ensures that each school maintains accurate and current medical records for all participating students.
The physical examination section of the EL2 form must be completed by a licensed physician, osteopathic physician, chiropractic physician, physician assistant, or certified advanced registered nurse practitioner. This ensures that the examination is thorough and conducted by a qualified professional.
The first part of the EL2 form requires detailed student information, including:
If a student is not cleared for sports participation based on the findings of the EL2 form:
Filling out the FHSAA EL2 form, a requirement for high school athletes in Florida, seems straightforward, but several common mistakes can lead to delays in participation. Here are seven frequent errors to avoid:
By carefully avoiding these mistakes, students, parents, and guardians can ensure a smoother process for participating in high school athletics in Florida.
When a student-athlete prepares for participation in school sports, the Florida High School Athletic Association (FHSAA) EL2 form, which is the Preparticipation Physical Evaluation, is a critical document. However, it’s often just one piece of the puzzle. Several other forms and documents typically accompany the EL2 form to ensure a comprehensive evaluation and compliance with school and state regulations. Understanding these forms can help streamline the process for students, parents, and school administrators.
Each of these documents plays a vital role in ensuring the safety and eligibility of student-athletes. Collectively, they contribute to a safe sporting environment that prioritizes the well-being of young athletes while fostering competitive sportsmanship. Ensuring that all required forms and documentation are completed and submitted on time helps in the smooth participation of students in high school athletics.
The NCAA Student-Athlete Pre-Participation Medical Evaluation Form is similar to the FHSAA EL2 form, as both are designed to evaluate an athlete's medical fitness for participation in sports. These forms contain sections for personal information, medical history, and physical examinations conducted by healthcare professionals. Each aims to screen for conditions that could make sports participation unsafe.
The School Admission Health Record shares aims with the FHSAA EL2 form, focusing on assessing general health rather than sports-specific fitness. It typically includes immunization records, a medical history, and results from a physical examination. Like the FHSAA EL2 form, it serves to protect the health of the individual and those around them within an institutional setting.
The Pre-Employment Physical Examination Form serves a similar purpose in the employment context, ensuring that an individual is medically and physically capable of performing a job safely. It often includes a detailed medical history and a physical examination, paralleling the thorough nature of the FHSAA EL2 form's approach to assess an individual's physical capacity and well-being.
The Boy Scouts of America (BSA) Annual Health and Medical Record is akin to the FHSAA EL2 form in its comprehensive approach to documenting health information for participants in activities that can be physically demanding. It includes detailed medical history, immunization records, and a physical exam to ensure the safety and readiness of individuals to partake in Boy Scouts' diverse and physically active programs.
When completing the FHSAA EL2 Preparticipation Physical Evaluation form, some practices can ensure the process is smooth and efficient, while others can cause delays or issues. Here are 10 do's and don'ts to keep in mind:
Adhering to these guidelines can help ensure the health and safety of students participating in athletics, streamlining the process for students, parents, and school administrators.
There are several misconceptions about the Florida High School Athletic Association (FHSAA) EL2 form, which is essential for high school athletes. Understanding the purpose, requirements, and limitations of this form is crucial for students, parents, and school officials. Below are seven common misconceptions and their clarifications.
The form is transferable between schools. Contrary to this belief, the EL2 form is not transferable. If a student changes schools, page 1 of the form must be re-submitted to the new school. This ensures that the new school has accurate and up-to-date information about the student's health and fitness for participation in athletics.
Once completed, the form is valid indefinitely. The validity of the EL2 form extends for 365 calendar days from the date of the medical evaluation as stated on page 2. This misconception might lead to students participating in sports with an outdated physical examination, potentially overlooking new health concerns.
Any medical professional can complete the form. The physical examination section of the EL2 form must be completed by a licensed physician, osteopathic physician, chiropractic physician, physician assistant, or certified advanced registered nurse practitioner. This ensures that a qualified professional assesses the student's physical fitness for sports participation.
The form is only about physical health. While it primarily focuses on physical health, the EL2 form also includes sections for medical history and student information. This comprehensive approach helps identify factors that might affect the student's safety and performance in sports.
Students and parents need not worry about the medical history section. In fact, the medical history section is crucial for identifying potential risks associated with sports participation. Honest and thorough completion of this section can help prevent medical emergencies on the field.
All students must undergo cardiac testing. The form advises that students should undergo a cardiovascular assessment, which may include tests like an EKG, ECG, or cardio stress test. However, this is advised and not mandated, leaving the decision to the parents, students, and their physicians.
A "cleared without limitation" assessment means the student is at no risk. Even though a student may be cleared to participate in sports without limitations, it does not eliminate all risk. It merely indicates that, at the time of examination, no medical reasons were found to restrict the student's participation in sports. Ongoing vigilance for health changes is important.
Understanding these aspects of the FHSAA EL2 form is vital for ensuring the safety and well-being of high school athletes in Florida. It highlights the importance of accurate information, adherence to guidelines, and the role of medical professionals in assessing student athletes' readiness for sports participation.
Here are key takeaways for filling out and using the FHSAA EL2 Form:
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