The FHSAA EL2 form is a critical document required by the Florida High School Athletic Association for student-athletes. This form serves as a preparticipation physical evaluation, ensuring that students are medically cleared to participate in sports. To get started, fill out the form by clicking the button below.
The FHSAA EL2 form is a crucial document for students aspiring to participate in sports within Florida's high school athletic programs. This form serves as a preparticipation physical evaluation, ensuring that students undergo a comprehensive health assessment before engaging in athletic activities. It is divided into several parts, beginning with essential student information, including the athlete's name, age, and school details. The medical history section requires thorough responses regarding past injuries, chronic illnesses, and other health-related queries. This section plays a vital role in identifying any potential health risks that could affect the student’s ability to participate safely in sports. Following this, a licensed healthcare professional must complete the physical examination portion, assessing various aspects of the student's health, including cardiovascular fitness, musculoskeletal condition, and overall physical appearance. The form is valid for one year from the date of the evaluation and is non-transferable, meaning that if a student changes schools within that timeframe, a new evaluation must be submitted. This process not only prioritizes the safety and well-being of student-athletes but also ensures compliance with state regulations governing high school sports.
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?
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 –
Preparticipation Physical Evaluation (Page 2 of 3)
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
Pupils: Equal _________ Unequal _________
FINDINGS
NORMAL
ABNORMAL FINDINGS
INITIALS*
MEDICAL
Appearance
________
________________________________________________________________________
____________
Eyes/Ears/Nose/Throat
Lymph Nodes
Heart
Pulses
Lungs
Abdomen
Genitalia (males only)
Skin
MUSCULOSKELETAL
Neck
Back
Shoulder/Arm
Elbow/Forearm
Wrist/Hand
Hip/Thigh
Knee
Leg/Ankle
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 –
Preparticipation Physical Evaluation (Page 3 of 3)
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):
Name of Physician (print): ___________________________________________________________________________________________ Date: ____/____/_______
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 –
Filling out the FHSAA EL 2 form is an essential step for student-athletes before they can participate in sports. This form gathers important information about the student’s health and medical history. Once the form is completed, it must be submitted to the school, where it will be kept on file for a year.
After submitting the form, the school will keep it on file for one year. If the student changes schools during this period, a new form will need to be submitted. Make sure to keep track of the evaluation date to ensure the form remains valid for participation in sports.
What is the FHSAA EL2 form?
The FHSAA EL2 form is a Preparticipation Physical Evaluation required by the Florida High School Athletic Association. It ensures that student-athletes undergo a thorough medical examination before participating in sports. This form collects essential health information and must be completed by a licensed medical professional.
Who needs to complete the EL2 form?
All student-athletes participating in school sports in Florida must complete the EL2 form. This includes students at both public and private schools. Parents or guardians should assist their children in filling out the form accurately.
How long is the EL2 form valid?
The EL2 form is valid for 365 calendar days from the date of the physical evaluation noted on page 2. After this period, a new evaluation and form submission will be necessary to continue participating in sports.
What happens if a student changes schools?
If a student changes schools during the validity period of the EL2 form, page 1 of the form must be resubmitted to the new school. The form is non-transferable, and schools cannot accept a form completed for another institution.
What information is required on the EL2 form?
The EL2 form requires detailed information about the student, including personal details such as name, age, and school. It also asks for medical history, emergency contact information, and details about any current medications or health issues. This comprehensive data helps ensure the safety of the student during sports activities.
Who can perform the physical examination?
A licensed physician, osteopathic physician, chiropractic physician, physician assistant, or certified advanced registered nurse practitioner must conduct the physical examination. This ensures that a qualified professional assesses the student's health before they participate in sports.
What should be done if there are "yes" answers in the medical history section?
If any "yes" answers are provided in the medical history section, it is essential to explain them in detail on the form. This information is crucial for the examining physician to understand any potential health risks and make informed decisions about the student’s ability to participate in sports.
Is parental consent required?
Yes, parental or guardian consent is mandatory. Both the student and their parent or guardian must sign the form, confirming that the information provided is accurate and complete. This signature indicates their understanding of the medical evaluation process.
What should be done if the student has a medical condition?
If a student has a pre-existing medical condition, it is vital to disclose this on the EL2 form. The examining physician will consider this information when assessing the student's fitness for sports participation. Additionally, it may be necessary to follow up with the physician for further evaluation or recommendations.
How can parents ensure the form is completed correctly?
Parents should review the EL2 form with their child before submitting it. Ensuring all sections are filled out accurately and completely is crucial. Additionally, they should make sure that the physical examination is conducted by a qualified professional and that all necessary signatures are obtained.
Completing the FHSAA EL2 form is a crucial step for student-athletes in Florida. However, many individuals make common mistakes that can lead to complications. One frequent error is failing to provide complete and accurate student information. This section includes essential details such as the student’s name, age, and sport. Omitting any of these details can delay the processing of the form, causing unnecessary stress.
Another common mistake involves the medical history section. Some parents or students do not thoroughly review the questions or skip them altogether. It is vital to answer all questions honestly and completely. For example, if a student has had a concussion, this information must be disclosed. Inaccurate or incomplete answers can jeopardize the student’s eligibility to participate in sports.
Additionally, many people overlook the importance of the signature section. Both the student and the parent or guardian must sign the form to validate it. A missing signature can render the form invalid, requiring the submission of a new one. This oversight can lead to delays in the student’s ability to participate in their chosen sport.
Another mistake occurs when individuals do not keep track of the form’s validity period. The FHSAA EL2 form is only valid for 365 days from the evaluation date. If a student changes schools during this period, the form must be re-submitted. Failing to monitor this timeline can lead to unexpected eligibility issues.
Lastly, some individuals neglect to consult with a physician before filling out the form. A thorough physical examination is essential to ensure the student’s health and safety while participating in sports. If a physician has recommended specific precautions or restrictions, these should be clearly noted on the form. Ignoring this step can put the student at risk and may lead to complications during athletic activities.
The FHSAA EL2 form is essential for student-athletes in Florida, ensuring that they undergo a thorough physical evaluation before participating in sports. However, several other documents complement this form to provide a complete picture of a student's health and eligibility. Here’s a list of related forms and documents you may encounter.
Each of these forms plays a vital role in safeguarding the health and well-being of student-athletes. It is crucial to complete and submit them accurately to ensure compliance with FHSAA regulations and to promote a safe sporting environment.
The FHSAA EL2 form is an important document for student athletes in Florida, ensuring their health and safety before participating in sports. Several other documents serve similar purposes in different contexts. Below are four documents that share similarities with the FHSAA EL2 form:
When filling out the FHSAA EL2 form, it is essential to approach the task with care and attention to detail. Here are seven important things to keep in mind, including both dos and don'ts.
By following these guidelines, you can help ensure that the FHSAA EL2 form is filled out correctly, which is vital for the safety and well-being of student-athletes.
Understanding the FHSAA EL 2 form is crucial for student-athletes and their families. However, several misconceptions can lead to confusion. Here are six common misunderstandings about this important document:
By clarifying these misconceptions, parents and students can better navigate the requirements of the FHSAA EL 2 form and ensure a smoother experience in the world of school sports.
When completing and using the FHSAA EL2 form, there are several important points to keep in mind: