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Fill Out a Valid Nj Sports Phisical Template

The New Jersey Sports Physical Form serves as a comprehensive health assessment tool, mandated by the New Jersey Department of Education, to ensure the safety and readiness of students participating in athletic activities. Comprising two parts, it includes a Health History Questionnaire (Part A), which must be filled out by both the parent and the student and then reviewed by the medical examiner, and a Physical Evaluation Form (Part B) to be completed by a licensed health care provider. This meticulous process is designed to identify any potential health risks before participation in sports, safeguarding the well-being of young athletes across New Jersey.

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Fill Out a Valid Nj Sports Phisical Template

Article Structure

The New Jersey Department of Education mandates that student-athletes undergo an Annual Athletic Pre-Participation Physical Examination to ensure they are fit for sports participation. This comprehensive process is divided into two main components: Part A, the Health History Questionnaire, and Part B, the Physical Evaluation Form. Part A solicits detailed family and personal medical history, provided by the student and their parent or guardian, to highlight any past conditions or illnesses that might impact the athlete's capacity to participate safely in sports activities. Questions cover a broad range of health issues, from chronic illnesses and allergies to previous injuries and mental health concerns, ensuring a thorough review of the student's health status. Part B, on the other hand, is a hands-on physical examination conducted by a licensed medical provider, such as an MD, DO, APN, or PA, to assess the student's current physical condition. This examination includes evaluating the general appearance, cardiovascular health, musculoskeletal system, among other areas, to ascertain the student's physical readiness. Both sections of the form, which must be completed annually, play a crucial role in safeguarding the health and safety of young athletes by identifying any potential risks for injury or complications while participating in sports.

Sample - Nj Sports Phisical Form

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

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

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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NJDOE/APPEF Revised 3/10		Use of this form is required by N.J.A.C. 6A:16-Programs to Support Student Development

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

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

	Part B Page 3 of 4
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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: ____________________________________________________________

_____________________________________________________________________________________

Part B Page 4 of 4

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

➤ PDF

Document Specifications

Fact Name	Description
Governing Regulation	Use of this form is mandated by N.J.A.C. 6A:16-Programs to Support Student Development.
Form Revision Date	The form was revised in March 2010.
Two-Part Form	The form consists of Part A for Health History Questionnaire and Part B for Physical Evaluation Form.
Required Participants	Part A must be completed by both the parent and the student, whereas Part B is to be filled out by a licensed provider with MD, DO, APN, or PA credentials.
Health History Specifics	Part A includes detailed questions on medical history, medications, allergies, and any past injuries or conditions across various categories.
Physical Evaluation Specifics	Part B examines the student’s general appearance, vital signs, vision, cardiovascular health, musculoskeletal condition, and more.
Mandatory Review	The health history provided in Part A must be reviewed by the examining provider at the time of the medical examination.
Signature Requirement	A signature from the parent/guardian or the student (if 18 years of age) is required, verifying the accuracy of the information provided.
Emergency Contact Information	Emergency contact details for a parent/guardian and an alternative contact are required, including relationships and multiple contact numbers.
Genders and Sports	The form requests information on the student’s gender and the sports they intend to participate in.

Detailed Steps for Using Nj Sports Phisical

Filling out the New Jersey Department of Education's Annual Athletic Pre-Participation Physical Examination Form is an essential step for students before participating in school sports activities. This comprehensive documentation ensures students are physically capable and healthy enough to engage in sports, thereby safeguarding their well-being. The form is divided into two parts: Part A, the Health History Questionnaire, which is to be filled out by the parent or guardian along with the student, and Part B, the Physical Evaluation Form, which is to be completed by a licensed medical provider. Here is a detailed guide to aid you through the process of accurately completing the form.

Filling Out Part A: Health History Questionnaire

Start with the basics: Enter today’s date and the date of the student's last sports physical. Fill in the student's name, circle the appropriate sex, and note the age, grade, date of birth, school, district, and the sport(s) the student intends to play.
Contact information: Provide the student's home phone number, the medical home or provider name, and the corresponding phone and fax numbers.
Emergency contact details: List the names, relationships, and contact numbers (work, home, cell) of the parent/guardian and an additional emergency contact.
Medical history questionnaire: Answer all the health-related questions, circling the appropriate response (Yes/No/Don’t Know). For any "yes" answers, provide explanations in the space provided below each set of questions. Include relevant dates and details.
Medication details: List all medications the student is taking, including the name, dosage, and frequency.
Parent/Guardian signature: After reviewing all the information provided, the parent/guardian or the student (if 18 years old) must sign and date the form, certifying the accuracy of the information.

Filling Out Part B: Physical Evaluation Form

Student and provider information: Fill in the student’s name, sports they will participate in, sex, age, grade, date of birth, home address, school, and district. If the exam is conducted by a school physician, check the appropriate box. Provide the examining provider's name, phone, fax, address, and city/state/zip.
Physical examination findings: This section is to be completed by the examining provider. It includes the student’s height, weight, blood pressure, pulse, and vision details. The provider should also note the general appearance and perform thorough evaluations of various bodily systems, annotating any normal or abnormal findings.
Observations and conclusions: The licensed provider should list any recent immunizations, current medications (with dosage and frequency), additional observations, general diagnosis, and general recommendations based on the physical exam.
Review of health history: The medical provider must review the health history prepared by the parent/student before concluding the physical examination.

Once both parts of the form are meticulously filled out and reviewed, it becomes a critical document, providing insight into the student's physical health status and readiness for sports participation. It's important for both parents/guardians and students to provide comprehensive and accurate information to ensure a safe and healthy sports experience.

Learn More on Nj Sports Phisical

NJ Sports Physical Form FAQ

What is the NJ Sports Physical Form?

The NJ Sports Physical Form is a document required by the New Jersey Department of Education for student-athletes. It comprises two parts: Part A, the Health History Questionnaire, to be completed by the parent and student, and Part B, the Physical Evaluation Form, to be completed by a licensed healthcare provider.

Who needs to complete the NJ Sports Physical Form?

Any student participating in school sports in New Jersey must have a completed NJ Sports Physical Form. This includes completing both the Health History Questionnaire (Part A) and the Physical Evaluation (Part B).

What health professionals are authorized to perform the physical evaluation?

The physical evaluation can be conducted by any of the following licensed professionals:

Medical Doctor (MD)
Doctor of Osteopathy (DO)
Advanced Practice Nurse (APN)
Physician Assistant (PA)

How often must the NJ Sports Physical Form be completed?

Students must undergo a sports physical and consequently complete the NJ Sports Physical Form annually to participate in school sports for that academic year.

Can a student participate in sports if any section of the form is not completed?

No, students may not participate in any school sports until both Part A and Part B of the NJ Sports Physical Form are fully completed and submitted. The form must also be reviewed by the examining healthcare provider during the physical examination.

What information is required in the Health History Questionnaire (Part A)?

Part A requires detailed information regarding the student’s health history, including but not limited to, past illnesses, injuries, allergies, medication usage, and any history of concussions or heart-related issues. It necessitates clear responses to each question and explanations for any “yes” answers.

What if a student has a health condition not listed on the form?

If a student has a health condition not explicitly addressed on the form, it should be reported in the section allocated for explaining "yes" responses. Detailed information about the condition, including how it is managed and any impact on physical activity, should be included. This ensures that the examining healthcare provider has a comprehensive understanding of the student’s health needs.

Common mistakes

When filling out the New Jersey Sports Physical form, it's common to stumble over some tricky sections. Avoiding mistakes can spare you from having to redo parts, delay in submission, or problems during review. Here are some common missteps to watch out for:

Not Completing Both Parts: The form is divided into Part A and Part B, with Part A requiring detailed health history information from the parent and student, and Part B involving the physical examination to be filled out by a licensed provider. Skipping or partially completing either section can lead to an incomplete application.
Forgetting to Circle Responses: The form asks yes/no/don't know questions that must be circled. Not circling an answer at all or marking it in a different way may result in confusion or incorrect assumptions about a student's health.
Omitting Details for "Yes" Responses: Any "yes" answer requires an explanation. Skipping these explanations leaves out critical health history context that could impact a student’s participation clearance.
Leaving Medication Details Blank: Listing all medications, including dosage and frequency, is vital. This information helps the examining provider understand the student's current health management strategies.
Ignoring the Emergency Contact Section: Fully completed emergency contact information is crucial for ensuring the safety of the student athlete. Missing or incomplete information in this section could delay emergency response if needed.
Inaccuracies in the Health History: Providing inaccurate or outdated information in Part A can lead to misinformed assessments by the examining provider. Always double-check dates, names of conditions, and other specifics.
Parent/Guardian Signature and Date: The form requires a signature from a parent, guardian, or the student (if 18). Missing this step means the form is not legally confirmed and could be considered invalid.

A few recommendations to ensure a smooth process include:

Review the entire form before starting to understand what’s required.
Gather all necessary information, including a complete medical history and any current medications, ahead of time.
Take your time filling out the form to ensure accuracy and completeness. Rushing can lead to mistakes.
Verify that all required sections are completed and reviewed by the necessary parties before submission.

Documents used along the form

When students participate in school sports in New Jersey, the Annual Athletic Pre-Participation Physical Examination Form is a critical document, ensuring they are physically and medically fit to engage in athletic activities. However, this document does not stand alone in the sports clearance process. Other forms and documents often accompany it, each serving a unique purpose in providing a comprehensive overview of a student's health status and readiness for sports participation. Here are six such forms:

Consent and Release Certificate: This form is a declaration signed by the student's parents or guardians, giving their child permission to participate in school sports. It often includes statements regarding the assumption of risk and agreements on following the school's athletic policies.
Emergency Medical Authorization Form: This document collects crucial information about the student's medical care preferences, health insurance details, and contact information for primary care physicians. It ensures that, in case of a medical emergency, school officials can act swiftly and according to the parents' wishes.
Concussion Acknowledgement Form: Given the increasing awareness and concern regarding concussions in youth sports, this form usually involves education on recognizing concussion symptoms and mandates that both student-athletes and their parents acknowledge the risks of concussions in sports.
Sudden Cardiac Arrest Awareness Form: This form educates and informs parents and athletes about the signs of sudden cardiac arrest, a condition that, while rare, can be life-threatening. By signing it, families confirm they understand the risks and symptoms associated with sudden cardiac arrest.
Asthma Treatment Plan Form: For students with asthma, this document outlines the prescribed treatment and actions to be taken in case of an asthma attack. It ensures that school coaches and health officials are prepared to manage the student's asthma effectively during physical activities.
Medication Administration Form: If a student needs to take medication during school hours or school-related events, this form provides authorization and instructions for the administration of prescription or over-the-counter medicines. It includes details about the medication's dosage, frequency, and other special instructions.

Together, these forms create a detailed and informed athletic participation profile for each student, ensuring safety and preparedness from multiple angles. Schools and parents work collaboratively, through comprehensive documentation, to promote a safe and positive sporting experience for students. Ensuring that all necessary forms are filled out accurately and completely is an essential step in the sports clearance process, reflecting a shared commitment to student health, safety, and well-being.

Similar forms

The New Jersey Department of Education Annual Athletic Pre-Participation Physical Examination Form shares similarities with various other types of health and fitness-related documents. A noteworthy example is the Pre-Employment Physical Examination Form, which, much like the sports physical form, assesses an individual's physical fitness and overall health to ensure they are capable of performing specific job duties. This form usually includes a health history questionnaire and a physical examination conducted by a licensed healthcare provider, similar to the structure of the NJ sports physical form.

Another related document is the School Entry Health Exam Requirement Form, which is required for students before they can enroll in public schools. This form evaluates a child’s health to ensure they are ready for school activities. It typically includes sections on vaccination history and overall health assessment, paralleling the health history and physical evaluation sections found in the NJ sports physical form.

The College Immunization Record is similar to the sports physical form's section on most recent immunizations. This document tracks a student's vaccination history to ensure they meet the college’s healthcare standards, focusing on preventing communicable diseases in a campus environment. Although its primary focus is on immunizations, it also reflects a commitment to student health and safety, akin to the sports physical form.

The Annual Employee Health Assessment forms used by employers to gauge the ongoing health and fitness of their employees also bear resemblance. These assessments often include questions about physical activity, chronic illnesses, and medication use, much like the health history questionnaire of the NJ sports physical form. They ensure employees maintain their health to perform their job functions safely and effectively.

The Fitness Membership Health Questionnaire, often required for joining a gym or fitness club, is used to identify any health concerns or limitations that might affect an individual’s exercise regimen. It includes health history questions and inquiries about current physical activity levels, echoing the sports physical form’s purpose to ensure safe participation in physical activities.

Driver’s Medical Evaluation Forms, necessary for individuals with certain health conditions seeking to obtain or renew their driver's license, also share similarities. These forms include assessments of physical and sometimes mental health conditions that could impact driving capabilities, mirroring the comprehensive health evaluation of the NJ sports physical form to ensure the safety of the individual and others.

The Childcare Provider Health Assessment Form, required for individuals working in childcare settings, evaluates one's health to ensure they can safely care for children. This form often includes both a self-reported health history and a physical examination by a healthcare provider, much like the dual components of the sports physical form, emphasizing the importance of health in responsibility roles.

Lastly, the Adventure Sports Waiver and Health Assessment Form, required by participants of high-risk recreational activities, closely relates to the NJ sports physical form. It assesses an individual’s health and physical condition to minimize the risk of injury during activities, incorporating elements of health history and sometimes a physical examination to ensure participant safety.

Dos and Don'ts

When completing the New Jersey Sports Physical Form, it is crucial to follow certain guidelines to ensure the information provided is accurate and clear. By adhering to these recommendations, you will help ensure a smooth evaluation process for eligibility in athletic activities.

Do's:

Read all instructions carefully before you begin filling out the form.
Ensure that the health history questionnaire (Part A) is completed fully by the parent or guardian and the student athlete.
Provide accurate and up-to-date medical information, including details of any past injuries, conditions, or surgeries.
List all medications, including over-the-counter and prescription, with dosages and frequencies.
Explain any "yes" responses in the health history section thoroughly, providing dates and details where applicable.
Ensure that the physical evaluation form (Part B) is completed by a licensed provider such as an MD, DO, APN, or PA.
Review the completed form for any errors or missing information before submission.
Update emergency contact information to ensure it is current.
Sign and date the form where required by both the parent/guardian and the student athlete if of legal age.
Keep a copy of the completed form for your records before submitting it to the school or athletic department.

Don'ts:

Don't leave any sections blank. If a question does not apply, write "N/A" (Not Applicable).
Don't rush through the questions. Incorrect or incomplete information can affect eligibility and safety.
Don't forget to indicate the date of the last physical exam clearly at the beginning of the form.
Don't provide false information or omit details about medical history, as this can pose risks during athletic participation.
Don't skip the explanation sections for any "yes" answers in the health history questionnaire.
Don't allow anyone other than a licensed medical professional to complete the physical examination form (Part B).
Don't forget to list any allergies, including reactions to medications, foods, or environmental factors.
Don't overlook the signature and date sections; unsigned forms may be deemed invalid.
Don't ignore the recommendations or follow-up actions suggested by the examining provider after the physical evaluation.
Don't submit the form without reviewing it for completeness and accuracy with the parent/guardian and student athlete.

Misconceptions

When it comes to New Jersey's sports physical forms, there's quite a bit of confusion out there. Let's clear the air on some of the most common misconceptions:

Only athletes need a sports physical. While it's called a sports physical, this examination provides valuable health information for any active child or adolescent, not just those on school sports teams. They assess fitness levels and identify potential risk factors for injury or disease that could be exacerbated by physical activity.
It's the same as an annual check-up. Though both involve a physical examination, a sports physical focuses specifically on an individual's ability to participate in sports. It's a screening tool for athletes' safety, whereas an annual physical is a comprehensive health review.
Every doctor will automatically know what the NJ sports physical form requires. While the New Jersey Department of Education requires the use of a specific form, not all healthcare providers may be immediately familiar with New Jersey's specific requirements. It's a good idea for parents or guardians to bring the form to the examination to ensure all needed information is captured.
A sports physical can only be performed by a family physician. The exam can be conducted by any licensed provider, including Medical Doctors (MD), Doctors of Osteopathy (DO), Advanced Practice Nurses (APN), or Physician Assistants (PA), as long as they complete Part B of the form. Schools often provide opportunities for sports physicals to be done on-site.
If you pass the sports physical, you're in perfect health. Passing a sports physical means you meet the minimum requirements for sports participation regarding health and fitness. It's not an exhaustive assessment of overall health, and it's possible for other health issues to exist that don't necessarily preclude sports participation.

Understanding the purpose, process, and specifics of the New Jersey sports physical form is essential for ensuring the safety and well-being of young athletes. Always consult with a healthcare professional for the most accurate and personalized advice.

Key takeaways

Understanding the process of completing the New Jersey Sports Physical Form is crucial for students, parents, and guardians anticipating participation in school athletics. Here are nine key takeaways to ensure a smooth and informed experience:

Thoroughness is key: The Health History Questionnaire (Part A) requires detailed information about the student's medical history, including any past injuries, illnesses, surgeries, allergies, and medication use. Providing complete and accurate responses helps identify any potential risks to the student athlete.
Collaboration between parents and students: Both the student and their parent or guardian must collaborate to complete Part A of the form. This collaborative approach ensures that all necessary information is accurately captured.
Review by a licensed provider: Part B of the form, the Physical Evaluation Form, must be completed by a licensed medical provider with credentials including MD, DO, APN, or PA. This requirement underscores the importance of a professional health assessment prior to athletic participation.
Emergency contact information: Providing up-to-date emergency contact information is vital. This ensures that parents or guardians can be reached promptly in case of an emergency.
Understanding the importance of yes responses: All "yes" answers on the Health History Questionnaire need additional explanations. This assists the examining healthcare provider in understanding the student's health background comprehensively.
Currency of the form: The New Jersey Department of Education requires the use of the current form as per N.J.A.C. 6A:16-Programs to Support Student Development. Always verify that the most recent version of the form is being used.
Immunization and medication records: Including the most recent immunization dates and an up-to-date list of medications, along with their dosage and frequency, is critical. This information aids in the overall assessment of the student's health status.
Physical examination details: The Physical Evaluation Form comprehensively assesses the student's general health, cardiovascular health, musculoskeletal condition, and more. Each section must be filled out meticulously, indicating normal findings and noting any abnormalities.
Signature requirement: The form requires the signature of the parent, guardian, or the student (if 18 or older). This is a declaration that the information provided is accurate to the best of their knowledge.

Adhering to these key points ensures a thorough and accurate assessment of a student's readiness for athletic participation, prioritizing their health and safety.

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