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04/20/15 – Updated Physical History and Exam, Permission Forms Posted

April 20, 2015 Athletic Department Blog Updates

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Thanks to great work by various groups, we are able to get revised physical and permission forms online a couple of weeks early this year as many of you plan for next year. All old forms that have been completed remain valid for the one year plus one month period from the date of administration as specified in the KHSAA Handbook, but any new exam should utilize the new form.

The Physical Form (both history and physician exam) forms have been separated from the permission form. This is after considerable requests from the membership due to the burden of middle school students taking the same physical and using it in different situations, both middle school students playing intra-middle school and those middle school students playing ‘up” to the high school level in permitted sports. The forms are now divided into three different forms:

  • GE04 – is the permission form for high school level play (freshman, JV, varsity), and is signed by both the student and the parents. This form may not be altered, but may be supplemented by local district additional forms or requirements. This form should continue to be maintained on file at the school until the student has turned 19 and graduated. There are basically no changes on the GE04 form with the exception of removing the health history and medical exam information and moving it to a separate form. Remaining in that form are the critical bits of information relative to permission to treat and insurance information. The form is required to be completed prior to any practice or play by the student. This form is located at http://khsaa.org/forms/ge04.pdf.
  • MS01 – is the permission form for middle school level play by any student for middle school level (students enrolled in grades 5-8 participating in competition for grades 6-8), and is signed by both the student and the parents. This form may not be altered, but may be supplemented by a local district, conference, association or other group additional forms or requirements. This form should continue to be maintained on file at the school until the student has exhausted middle school eligibility, enrolled in high school and reached the age of sixteen (16). There are basically no changes in the MS01 with the exception of removing the health history and medical exam information and moving it to a separate form. Remaining in that form are the critical bits of information relative to permission to treat and optional insurance information. The form is required to be completed prior to any practice or play by the student and is the only permitted form. This form is located at http://khsaa.org/forms/ms01.pdf.
  • PPE/Physical Form – is the new form to be completed by the family with health history information, and on the back side, the new physician clearance form. The health history and exam forms have been revamped and include the form recommended by the American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. This standard form replaces all prior versions of the physical form and is integrated into the GE04.
  • PPE/Physical Form – Supplemental History Form – Special Needs – is a totally optional form which can be used to supplement the history information for students with special needs. This health history supplement is recommended by the American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine but is totally discretionary for use by the medical practitioner. This optional form is located at http://khsaa.org/forms/ge05-ppe-historyformsupplementalforspecialneeds.pdf.

ALL OLD FORMS THAT HAVE BEEN COMPLETED REMAIN VALID FOR THE ONE YEAR PLUS ONE MONTH PERIOD FROM THE DATE OF ADMINISTRATION AS SPECIFIED WITHIN THE KHSAA HANDBOOK, BUT ANY NEW EXAM SHOULD UTILIZE THE NEW FORM

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