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H511.336 (Rev. 9/2012) Page 1 of 4: STUDENTHISTORYBureau of Community Health Systems Division of School Health Private or School PHYSICAL EXAMINATION OF SCHOOL AGE STUDENT PARENT / GUARDIAN / STUDENT:
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How to fill out private or school physical

01
Obtain the required physical form from the school or medical provider.
02
Fill out personal information such as name, date of birth, and address.
03
Provide medical history information such as previous illnesses, surgeries, or medications.
04
Complete the section on vaccinations and immunizations.
05
Have a licensed healthcare provider perform the physical examination and sign off on the form.
06
Return the completed form to the school or appropriate institution by the specified deadline.

Who needs private or school physical?

01
Students who are participating in school sports or extracurricular activities.
02
Students enrolling in a new school or district.
03
Individuals entering certain professions or programs that require physical examinations.

What is Private or School Physical Examination Form?

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Private or school physical is a medical examination required for students before they can participate in school activities or sports.
Students who wish to participate in school activities or sports are required to file a private or school physical.
Private or school physical forms can be filled out by a licensed healthcare provider during a medical examination of the student.
The purpose of private or school physical is to ensure that students are medically fit to participate in school activities or sports.
Private or school physical forms typically require information such as medical history, current medications, allergies, and any physical limitations.
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