AIA Physical Forms

 

15.7.1 A student shall not be allowed to practice or compete in interscholastic athletics until there is on file with the principal or his/her designee a record of a preparticipation physical examination (PPE) performed by a doctor of medicine (M.D.), an osteopathic physician (D.O.), a naturopathic physician (N.D., N.M.D.), a certified registered nurse practitioner (N.P.) licensed to practice, a certified physician's assistant (PA-C) registered by the Joint Board Of Medical Examiners and the Osteopathic Examiners in Medicine and Surgery, or a certified chiropractic sports physician (CCSP). The physical examination for the following school year shall be given on or after March 1. The physical examination card on file shall be signed by one of the aforementioned medical providers and shall state that, in the opinion of the examining provider, the provider did not find any medical reason to disqualify the student from practice or competition in athletic contests. The principal or his/her designee, if deemed advisable, may require a student to be reexamined.

15.7.2 Member schools shall utilize the physical examination forms provided by the AIA. There shall be three parts:

15.7.2.1 Part One – Annual Preparticipation Physical Evaluation – To be completed and signed by the parent or guardian and student athlete. This form must also be signed by the examining medical provider. (See Form 15.7-A).

15.7.2.2 Part Two – Annual Preparticipation Physical Examination – To be completed and signed by the examining medical provider. (See Form 15.7-B).

15.7.2.3 Part Three – Annual Preparticipation Acknowledgement – To be completed and signed by parent or guardian and student athlete. (See Form 15.7-C).