MO MSHSAA Pre-Participation Physical Evaluation 2016-2025 free printable template

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...

How to fill out mshsaa physical form

How to fill out MO MSHSAA Pre-Participation Physical Evaluation

1. Obtain the MO MSHSAA Pre-Participation Physical Evaluation form from your school's athletics office or the MSHSAA website.
2. Complete the personal information section, including the athlete's name, date of birth, and school.
3. Fill out the medical history portion, answering questions about previous medical conditions, surgeries, and family medical history.
4. Have a parent or guardian review and sign the consent section.
5. Schedule an appointment with a licensed healthcare provider for the physical examination.
6. During the examination, the healthcare provider will assess the athlete's overall health and fitness, checking vital signs, vision, and any specific concerns.
7. Once completed, the healthcare provider will fill out and sign the evaluation form, documenting the results of the physical exam.
8. Return the completed and signed form to your school's athletics office before participation in sports.

Who needs MO MSHSAA Pre-Participation Physical Evaluation?

1. All student-athletes participating in MSHSAA-sanctioned sports.
2. Students who are trying out for a sports team for the first time.
3. Any athlete who has had a change in health status since their last evaluation.

People Also Ask about sports physical form

How do you code a sports physical?

CPT code 99212 and diagnosis code Z02. 5 should be used to bill for a sports physical. No additional modifier is needed.

What happens at a sports physical for a girl?

Physical Examination check your blood pressure and pulse (heart rate and rhythm) test your vision. check your heart and lungs. examine your muscles, bones, and joints.

Is a sports physical different from a regular physical?

A sports physical is different than the annual physical because it focuses on reviewing your child's current health status and medical history to ensure that your child is healthy enough to play his or her sport.

How long are physicals good for?

Sports physicals are typically valid for one calendar year.

How long is a sports physical good for in Missouri?

Sports physicals are usually good for 1 year, though you probably will have to complete a sports form each season.

Is a physical good for 2 years?

General adult physical schedule: For ages 19-21, once every 2-3 years. For ages 22-64, once ever 1-3 years. Over 65, once a year.

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What is MO MSHSAA Pre-Participation Physical Evaluation?

The MO MSHSAA Pre-Participation Physical Evaluation is a medical examination required for student-athletes in Missouri to ensure they are physically fit to participate in sports activities.

Who is required to file MO MSHSAA Pre-Participation Physical Evaluation?

Student-athletes who wish to participate in any interscholastic sports governed by the Missouri State High School Activities Association (MSHSAA) are required to file the evaluation.

How to fill out MO MSHSAA Pre-Participation Physical Evaluation?

To fill out the MO MSHSAA Pre-Participation Physical Evaluation, a parent or guardian must complete the demographic information section and a healthcare provider must perform a physical examination, documenting any findings and signing the form.

What is the purpose of MO MSHSAA Pre-Participation Physical Evaluation?

The purpose of the evaluation is to identify any medical conditions that may pose risks to the student-athlete's health during participation in sports, thereby ensuring their safety and fitness.

What information must be reported on MO MSHSAA Pre-Participation Physical Evaluation?

The evaluation must report personal information including the athlete's name, date of birth, health history, physical examination results, and any clearance or disqualification recommendations by the examining physician.