Fall PPE due by July 18th/ Re-eval (HHQ) due before July 13th
Winter PPE due by Oct 21st / Re-eval (HHQ) due before Oct 14th
Spring PPE due by Feb 14th / Re-eval (HHQ) due before Feb. 10th
SCHOLASTIC STUDENT-ATHLETE SAFETY ACT
INFORMATION FACT SHEET
Prior to participation on a school-sponsored interscholastic or intramural athletic team or squad, each student-athlete in grades six through 12 must present a completed pre-participation physical evaluation (PPE) form (attached) to the School Nurse. Important information regarding the PPE is provided below, and you should feel free to share with your child’s medical home health care provider.
1. MANDATORY!! The PPE may ONLY be completed by a licensed physician, advanced practice nurse (APN) or physician assistant (PA)- that has completed the Student-Athlete Cardiac Assessment professional development module. It is recommended that you verify that your medical provider has completed this module before scheduling an appointment for a PPE.
2. The required PPE must be conducted within 365 days prior to the first official practice in an athletic season.
3. The parent/guardian must complete the entire packet that is attached. (If the nurse has your physical on file and it is less than 365 days since your previous physical- see number 6).
4. The licensed physician, APN or PA who performs the physical examination must complete the remaining two pages of the PPE, and insert the date of the examination on the top of the Physical Examination form and the Clearance form.
5. THE PACKET WILL BE RETURNED IF:
a. The top of each page with date of exam and personal information (name, etc.) is not filled in
b. Blood pressure and vision section is blank
c. Signatures are missing (athlete and parents)
d. Doctor’s signature is missing on any page (there are 3 areas for physicians signature- 4 if completing the School Medication Authorization)
e. Completed Cardiac Assessment is not signed by physician
6. For student-athletes that had a medical examination completed more than 90 days prior to the first official practice in an athletic season, the Health History Update Questionnaire (HHQ) form must be completed, and signed by the student’s parent/guardian. The HHQ must be reviewed by the school nurse, and if applicable, the school’s athletic trainer.
7. Athletes and parents must register on Genesis. More information will be available on this the end of May.
To view the a copy of the PHS Student Athlete Handbook (Click Here)