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The FHSAA EL2 form plays a crucial role in ensuring student-athletes are medically fit to participate in sports. This comprehensive document is designed to gather essential information about the student’s health history and current medical status. It includes sections for student and parent details, a thorough medical history questionnaire, and a physical examination conducted by a licensed healthcare professional. The form must be completed annually and kept on file by the school for 365 days from the date of the evaluation. It is important to note that the EL2 form is non-transferable; if a student changes schools during its validity, a new submission is required. The medical history section covers various health concerns, from past injuries to chronic illnesses, while the physical examination assesses overall health and fitness levels. By completing this form, parents and guardians help ensure that their children are ready for the physical demands of their chosen sports, promoting safety and well-being in school athletics.

Fhsaa El 2 Example

EL2

Florida High School Athletic Association

Preparticipation Physical Evaluation (Page 1 of 3)

REVISED 03/16

This completed form must be kept on ile by the school. This form is valid for 365 calendar days from the date of the evaluation as written on page 2.

This form is non-transferable; a change of schools during the validity period of this form will require page 1 of this form to be re-submitted.

Part 1. Student Information (to be completed by student or parent)

Student’s Name: ________________________________________________________________________ Sex: _____ Age: _____ Date of Birth: _____/ _____/ _____

School: ____________________________________________________ Grade in School: _____ Sport(s): ________________________________________________

Home Address: _______________________________________________________________________________________ Home Phone: ( _____) _______________

Name of Parent/Guardian: _______________________________________________________________ E-mail: ___________________________________________

Person to Contact in Case of Emergency: _____________________________________________________________________________________________________

Relationship to Student: _______________________ Home Phone: ( _____) ______________ Work Phone: ( _____) _____________ Cell Phone: ( _____) _____________

Personal/Family Physician: ___________________________________________City/State: ___________________________ Ofice Phone: ( _____) _____________

Part 2. Medical History (to be completed by student or parent). Explain “yes” answers below. Circle questions you don’t know answers to.

 

 

Yes

No

1.

Have you had a medical illness or injury since your last

____

____

 

check up or sports physical?

 

 

2.

Do you have an ongoing chronic illness?

____

____

3.

Have you ever been hospitalized overnight?

____

____

4.

Have you ever had surgery?

____

____

5.

Are you currently taking any prescription or non-

____

____

 

prescription (over-the-counter) medications or pills or

 

 

 

using an inhaler?

 

 

6.

Have you ever taken any supplements or vitamins to

____

____

 

help you gain or lose weight or improve your

 

 

 

performance?

 

 

7.

Do you have any allergies (for example, pollen, latex,

____

____

 

medicine, food or stinging insects)?

 

 

8.

Have you ever had a rash or hives develop during or

____

____

 

after exercise?

 

 

9.

Have you ever passed out during or after exercise?

____

____

10.

Have you ever been dizzy during or after exercise?

____

____

11.

Have you ever had chest pain during or after exercise?

____

____

12.

Do you get tired more quickly than your friends do

____

____

 

during exercise?

 

 

13.

Have you ever had racing of your heart or skipped

____

____

 

heartbeats?

 

 

14.

Have you had high blood pressure or high cholesterol?

____

____

15.

Have you ever been told you have a heart murmur?

____

____

16.

Has any family member or relative died of heart

____

____

 

problems or sudden death before age 50?

 

 

17.

Have you had a severe viral infection (for example,

____

____

 

myocarditis or mononucleosis) within the last month?

 

 

18.

Has a physician ever denied or restricted your

____

____

 

participation in sports for any heart problems?

 

 

19.

Do you have any current skin problems (for example,

____

____

 

itching, rashes, acne, warts, fungus, blisters or pressure sores)?

 

20.

Have you ever had a head injury or concussion?

____

____

21.

Have you ever been knocked out, become unconscious

____

____

 

or lost your memory?

 

 

22.

Have you ever had a seizure?

____

____

23.

Do you have frequent or severe headaches?

____

____

24.

Have you ever had numbness or tingling in your arms,

____

____

 

hands, legs or feet?

 

 

25. Have you ever had a stinger, burner or pinched nerve?

____

____

 

 

 

 

 

Yes

No

26.

Have you ever become ill from exercising in the heat?

____

____

27.

Do you cough, wheeze or have trouble breathing during or after

____

____

 

activity?

 

 

 

 

 

28.

Do you have asthma?

 

 

____

____

29.

Do you have seasonal allergies that require medical treatment?

____

____

30.

Do you use any special protective or corrective equipment or

____

____

 

medical devices that aren’t usually used for your sport or position

 

 

 

(for example, knee brace, special neck roll, foot orthotics, shunt,

 

 

 

retainer on your teeth or hearing aid)?

 

 

 

31.

Have you had any problems with your eyes or vision?

____

____

32.

Do you wear glasses, contacts or protective eyewear?

____

____

33.

Have you ever had a sprain, strain or swelling after injury?

____

____

34.

Have you broken or fractured any bones or dislocated any joints?

____

____

35.

Have you had any other problems with pain or swelling in muscles,

____

____

 

tendons, bones or joints?

 

 

 

 

 

If yes, check appropriate blank and explain below:

 

 

 

___ Head

___ Elbow

___ Hip

 

 

 

___ Neck

___ Forearm

___ Thigh

 

 

 

___ Back

___ Wrist

 

___ Knee

 

 

 

___ Chest

___ Hand

 

___ Shin/Calf

 

 

 

___ Shoulder

___ Finger

___ Ankle

 

 

 

___ Upper Arm

___ Foot

 

 

 

 

36.

Do you want to weigh more or less than you do now?

____

____

37.

Do you lose weight regularly to meet weight requirements for your

____

____

 

sport?

 

 

 

 

 

38.

Do you feel stressed out?

 

 

____

____

39.

Have you ever been diagnosed with sickle cell anemia?

____

____

40.

Have you ever been diagnosed with having the sickle cell trait?

____

____

41.

Record the dates of your most recent immunizations (shots) for:

 

 

 

Tetanus: _______________

Measles: _______________

 

 

 

Hepatitus B: ____________

Chickenpox: ____________

 

 

FEMALES ONLY (optional)

42.When was your irst menstrual period? _______________________

43.When was your most recent menstrual period? _________________

44.How much time do you usually have from the start of one period to the start of another?_______________________________________

45.How many periods have you had in the last year? _______________

46.What was the longest time between periods in the last year? ________

Explain “Yes” answers here:_______________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________

We hereby state, to the best of our knowledge, that our answers to the above questions are complete and correct. In addition to the routine medical evaluation required by s.1006.20, Florida Statutes, and FHSAA Bylaw 9.7, we understand and acknowledge that we are hereby advised that the student should undergo a cardiovascular assessment, which may include such diagnostic tests as electrocardiogram (EKG), echocardiogram (ECG) and/or cardio stress test.

Signature of Student: _____________________________________ Date: ____/ ____/ ____ Signature of Parent/Guardian: __________________________________ Date: ____/ ____/ ____

– 1 –

EL2

Florida High School Athletic Association

Preparticipation Physical Evaluation (Page 2 of 3)

REVISED 03/16

This completed form must be kept on ile by the school. This form is valid for 365 calendar days from the date of the evaluation as written on page 2.

This form is non-transferable; a change of schools during the validity period of this form will require page 1 of this form to be re-submitted.

Part 3. Physical Examination (to be completed by licensed physician, licensed osteopathic physician, licensed chiropractic physi- cian, licensed physician assistant or certiied advanced registered nurse practitioner).

Student’s Name: _____________________________________________________________________________________________ Date of Birth: _____/_____/_____

Height: _____________ Weight: _____________ % Body Fat (optional): ____________ Pulse: _________ Blood Pressure: ____ / ____ ( ____/____ , ____ /____ )

Temperature: _____________ Hearing: right: P ______ F _____ left: P _____ F _____

 

Visual Acuity: Right 20/_______

Left 20/_______

Corrected: Yes

No

Pupils: Equal _________ Unequal _________

 

FINDINGS

NORMAL

 

 

ABNORMAL FINDINGS

INITIALS*

MEDICAL

 

 

 

 

 

1.

Appearance

________

________________________________________________________________________

____________

2.

Eyes/Ears/Nose/Throat

________

________________________________________________________________________

____________

3.

Lymph Nodes

________

________________________________________________________________________

____________

4.

Heart

________

________________________________________________________________________

____________

5.

Pulses

________

________________________________________________________________________

____________

6.

Lungs

________

________________________________________________________________________

____________

7.

Abdomen

________

________________________________________________________________________

____________

8.

Genitalia (males only)

________

________________________________________________________________________

____________

9.

Skin

________

________________________________________________________________________

____________

MUSCULOSKELETAL

 

 

 

 

 

10.

Neck

________

________________________________________________________________________

____________

11.

Back

________

________________________________________________________________________

____________

12.

Shoulder/Arm

________

________________________________________________________________________

____________

13.

Elbow/Forearm

________

________________________________________________________________________

____________

14.

Wrist/Hand

________

________________________________________________________________________

____________

15.

Hip/Thigh

________

________________________________________________________________________

____________

16.

Knee

________

________________________________________________________________________

____________

17.

Leg/Ankle

________

________________________________________________________________________

____________

18.

Foot

________

________________________________________________________________________

____________

* – station-based examination only

ASSESSMENT OF EXAMINING PHYSICIAN/PHYSICIAN ASSISTANT/NURSE PRACTITIONER

I hereby certify that each examination listed above was performed by myself or an individual under my direct supervision with the following conclusion(s):

____ Cleared without limitation

____ Disability: _____________________________________________________ Diagnosis: ___________________________________________________________

_______________________________________________________________________________________________________________________________________

____ Precautions: ________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________________

____ Not cleared for: __________________________________________________________________________ Reason: ___________________________________

_______________________________________________________________________________________________________________________________________

____ Cleared after completing evaluation/rehabilitation for: ______________________________________________________________________________________

____ Referred to ______________________________________________________________________________ For: ______________________________________

_______________________________________________________________________________________________________________________________________

Recommendations: _______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________________

Name of Physician/Physician Assistant/Nurse Practitioner (print): __________________________________________________________ Date: _____/_____/_______

Address: _______________________________________________________________________________________________________________________________

Signature of Physician/Physician Assistant/Nurse Practitioner: ____________________________________________________________________________________

– 2 –

EL2

Florida High School Athletic Association

Preparticipation Physical Evaluation (Page 3 of 3)

REVISED 03/16

This completed form must be kept on ile by the school. This form is valid for 365 calendar days from the date of the evaluation as written on page 2.

This form is non-transferable; a change of schools during the validity period of this form will require page 1 of this form to be re-submitted.

Student’s Name: _____________________________________________________________________________________________

ASSESSMENT OF PHYSICIAN TO WHOM REFERRED (if applicable)

I hereby certify that the examination(s) for which referred was/were performed by myself or an individual under my direct supervision with the following conclusion(s):

____ Cleared without limitation

____ Disability: _____________________________________________________ Diagnosis: ___________________________________________________________

_______________________________________________________________________________________________________________________________________

____ Precautions: ________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________________

____ Not cleared for: __________________________________________________________________________ Reason: ___________________________________

____ Cleared after completing evaluation/rehabilitation for: ______________________________________________________________________________________

Recommendations: _______________________________________________________________________________________________________________________

Name of Physician (print): ___________________________________________________________________________________________ Date: ____/____/_______

Address: _______________________________________________________________________________________________________________________________

Signature of Physician: ___________________________________________________________________________________________________________________

Based on recommendations developed by the American Academy of Family Physicians, American Academy of Pediatrics, American Medical Society for Sports Medicine, American Orthopae- dic Society for Sports Medicine and American Osteopathic Academy for Sports Medicine.

– 3 –

Click for Fhsaa El 2 File

File Breakdown

Fact Name Details
Form Purpose The EL2 form is designed for preparticipation physical evaluations for students wishing to engage in sports.
Validity Period This form remains valid for 365 calendar days from the date of the evaluation noted on page 2.
Non-Transferability The form is non-transferable; changing schools during its validity requires re-submission of page 1.
Completion Requirement It must be completed by a licensed physician, physician assistant, or certified advanced registered nurse practitioner.
Emergency Contact Information for a person to contact in case of an emergency is required on the form.
Medical History Part 2 of the form includes a series of health-related questions that must be answered by the student or parent.
Physical Examination Part 3 involves a physical examination with findings that must be documented by the examining medical professional.
Governing Laws The form is governed by s.1006.20, Florida Statutes, and FHSAA Bylaw 9.7.
Immunization Records Students must record the dates of their most recent immunizations on the form.

Guide to Using Fhsaa El 2

The FHSAA EL 2 form is a crucial document for student-athletes participating in sports. It requires accurate information about the student’s health and medical history. Completing this form correctly ensures that the school has the necessary information to support the athlete's safety and well-being.

  1. Begin by filling out the Student Information section. Provide the student’s name, sex, age, date of birth, school, grade, sport(s), home address, and home phone number.
  2. Enter the name of the parent or guardian and their email address.
  3. List the person to contact in case of an emergency, along with their relationship to the student and contact numbers (home, work, and cell).
  4. In the Medical History section, answer each question with a "Yes" or "No." Circle any questions where you do not know the answer.
  5. If any questions are answered "Yes," provide explanations in the designated area.
  6. Record the dates of the student’s most recent immunizations for tetanus, measles, hepatitis B, and chickenpox.
  7. If applicable, complete the FEMALES ONLY section regarding menstrual history.
  8. Both the student and parent/guardian must sign and date the form, confirming the accuracy of the information provided.
  9. Ensure that the form is kept on file by the school for the required duration.

Get Answers on Fhsaa El 2

  1. What is the FHSAA EL2 form?

    The FHSAA EL2 form is a Preparticipation Physical Evaluation required for student-athletes in Florida. It ensures that students are medically cleared to participate in sports. The form collects information about the student's health history and requires a physical examination by a licensed healthcare provider.

  2. How long is the FHSAA EL2 form valid?

    This form is valid for 365 calendar days from the date of the physical evaluation noted on the second page. After this period, a new evaluation and form must be completed for continued participation in sports.

  3. Who needs to complete the FHSAA EL2 form?

    Both the student and a parent or guardian must complete parts of the form. The student provides personal information and medical history, while a licensed physician or qualified healthcare provider must perform the physical examination.

  4. What happens if a student changes schools?

    If a student transfers to a different school while the EL2 form is still valid, page 1 of the form must be re-submitted to the new school. The form is non-transferable, meaning it cannot be used at a different school without this step.

  5. What information is collected on the EL2 form?

    The form collects various details, including:

    • Student's name, age, and date of birth
    • School and grade information
    • Emergency contact details
    • Medical history, including any past illnesses or injuries
    • Results from the physical examination

  6. What should be done if there are “yes” answers in the medical history section?

    If any questions in the medical history section are answered with “yes,” the student or parent should provide explanations in the designated area. This information helps healthcare providers assess any potential risks associated with the student’s participation in sports.

  7. Can a student participate in sports without the EL2 form?

    No, a student cannot participate in any sports activities without a completed and valid FHSAA EL2 form. This requirement ensures that all athletes are medically cleared and safe to engage in physical activities.

  8. Where should the completed FHSAA EL2 form be kept?

    The completed form must be kept on file by the school. It is important for the school to have access to this information in case of emergencies or medical needs during sports activities.

Common mistakes

Filling out the FHSAA EL2 form is an essential step for student-athletes, but it can be tricky. Many people make common mistakes that can lead to delays or complications. Here are nine mistakes to watch out for when completing this important document.

First, one of the most frequent errors is failing to provide complete student information. Each section, including the student’s name, age, and school, must be filled out accurately. Incomplete information can result in the form being rejected, which could delay the student’s eligibility to participate in sports.

Second, people often neglect to update medical history. If there have been any changes in the student’s health since the last physical, these must be reported. This includes new medications, surgeries, or chronic conditions. Omitting this information can lead to serious health risks during sports activities.

Another common mistake is not circling questions with unknown answers. If a parent or student is unsure about a specific medical history question, they should circle it. This indicates to the physician that further clarification may be needed. Ignoring this can lead to misunderstandings during the medical evaluation.

Fourth, some individuals forget to include emergency contact information. This section is crucial in case of an emergency during sports activities. Providing accurate and up-to-date contact details ensures that the student can be reached quickly if needed.

Fifth, the signature section is often overlooked. Both the student and parent or guardian must sign the form. Failing to provide these signatures renders the form invalid, meaning it cannot be processed.

Sixth, people sometimes do not double-check the validity period. The FHSAA EL2 form is only valid for 365 days from the date of the evaluation. If the form is submitted after this period, it will need to be redone, wasting time and effort.

Seventh, some parents may not realize that the form is non-transferable. If a student changes schools, page one of the form must be resubmitted. This can catch families off guard if they are not aware of the policy.

Eighth, individuals often forget to provide the most recent immunization dates. This information is vital for the school to ensure the health and safety of all students. Missing immunization records can lead to complications with enrollment.

Finally, many people fail to review the entire form before submission. Taking a moment to go through the completed form can help catch any mistakes or omissions. A thorough review can prevent unnecessary delays and ensure that the student is ready to participate in sports.

By being aware of these common mistakes, parents and students can navigate the FHSAA EL2 form more effectively, ensuring a smooth process for athletic participation.

Documents used along the form

The FHSAA EL2 form is essential for student-athletes in Florida, as it ensures they undergo a thorough preparticipation physical evaluation. However, several other documents often accompany this form to provide a comprehensive overview of a student's health and eligibility for sports participation. Below is a list of these important forms and documents.

  • FHSAA EL3 Form: This form is a consent and release of liability waiver that must be signed by the student and parent or guardian. It outlines the risks associated with sports participation and confirms that the student has permission to compete.
  • FHSAA EL4 Form: This document is used to report any medical conditions or disabilities that may affect a student’s ability to participate in sports. It provides important information for coaches and medical staff.
  • Immunization Records: Schools often require a copy of the student’s immunization records to ensure they are up-to-date on required vaccinations, which is crucial for health and safety in sports.
  • Insurance Information: This document provides details about the student’s health insurance coverage, ensuring that any medical expenses incurred during sports activities can be addressed.
  • Emergency Contact Form: This form lists individuals to contact in case of an emergency. It includes names and phone numbers, ensuring that help can be reached quickly if needed.
  • Academic Eligibility Form: This form verifies that the student meets academic requirements set by the school or the FHSAA. It confirms that the student is maintaining satisfactory academic performance.
  • Concussion Awareness Form: This document educates students and parents about the signs and symptoms of concussions. It must be signed to acknowledge understanding of the risks associated with head injuries.
  • Drug Testing Consent Form: Some schools require this form to obtain consent for drug testing of student-athletes. It ensures compliance with school policies regarding substance use.
  • Medical Release Form: This form grants permission for medical personnel to provide treatment to the student in case of an injury or medical emergency during sports activities.
  • Parent/Guardian Consent Form: This document is needed for parents or guardians to give their consent for the student to participate in specific sports. It confirms that they understand the nature of the sport and any associated risks.

These documents work together to create a safe and supportive environment for student-athletes. Ensuring that all forms are completed accurately and submitted on time is crucial for a smooth sports experience. This helps protect the health and well-being of young athletes while allowing them to enjoy their sports activities fully.

Similar forms

  • FHSAA EL3 Form: Similar to the EL2 form, the EL3 form is used for student-athlete medical evaluations. It includes information about medical history and physical examinations, ensuring that students are cleared for participation in sports.
  • FHSAA EL5 Form: This form is a consent form for participation in interscholastic athletics. Like the EL2, it requires signatures from parents or guardians, emphasizing the importance of parental involvement in the student-athlete's health and safety.
  • FHSAA EL6 Form: The EL6 form is a report of injury or illness. It is similar in that it documents health-related issues but focuses specifically on incidents that occur during sports activities, ensuring proper follow-up and care.
  • Preparticipation Physical Evaluation (PPE) Form: This document is often required by schools and sports organizations. It assesses a student's physical fitness and health status, much like the EL2, to determine their readiness for sports.
  • Emergency Contact Form: While the EL2 includes emergency contact information, a dedicated emergency contact form may provide more detailed instructions for medical emergencies, ensuring that all necessary information is readily available.
  • Immunization Records: Similar to the EL2, which asks for immunization dates, these records provide a comprehensive overview of a student’s vaccinations, helping schools maintain health standards and protect against outbreaks.

Dos and Don'ts

When filling out the FHSAA EL2 form, it is important to follow certain guidelines to ensure the process is completed correctly. Below is a list of what to do and what to avoid.

  • Do ensure all personal information is accurate and complete.
  • Do include emergency contact information for quick access.
  • Do answer all medical history questions honestly and thoroughly.
  • Do have a licensed physician complete the physical examination section.
  • Do keep a copy of the completed form for your records.
  • Don't leave any sections blank; incomplete forms may be rejected.
  • Don't use abbreviations or shorthand in your answers.
  • Don't forget to sign the form; both student and guardian signatures are required.
  • Don't submit the form without confirming that it is within the validity period.

Misconceptions

Understanding the FHSAA EL2 form is crucial for student-athletes and their families. However, there are several misconceptions surrounding this important document. Here are four common misunderstandings:

  • The EL2 form is only necessary for certain sports. This is not true. The EL2 form is required for all student-athletes participating in any school-sponsored sport, regardless of the type.
  • Once the form is submitted, it doesn’t need to be updated. This is a misconception. The form is valid for only 365 days from the date of the physical evaluation. If a student changes schools during this period, the form must be resubmitted.
  • Only a doctor can fill out the EL2 form. While a licensed physician must complete the physical examination section, parents or students can fill out the personal and medical history parts of the form.
  • The EL2 form covers all medical concerns indefinitely. This is misleading. The form is a snapshot of the student's health at the time of evaluation. Any new medical issues or changes in health should be reported immediately to the school and may require additional documentation.

It is essential to keep these points in mind to ensure compliance and the safety of student-athletes. Understanding the requirements of the EL2 form can help facilitate a smooth athletic experience.

Key takeaways

Key Takeaways for Filling Out and Using the FHSAA EL2 Form:

  • The form must be completed annually and is valid for 365 days from the evaluation date.
  • All sections, including student information and medical history, should be filled out accurately by the student or parent.
  • It is essential to explain any "yes" answers in the designated area to provide clarity on medical conditions.
  • The form is non-transferable; if a student changes schools, page 1 must be resubmitted.
  • A licensed physician, physician assistant, or nurse practitioner must complete the physical examination section.
  • Keep a copy of the completed form on file at the school for reference and verification.
  • Ensure signatures from both the student and parent/guardian are obtained before submission.