Serving Kentucky's Schools and Student Athletes Since 1917

05/16/23- Revised GE04 and Optional PPE01 Released

May 16, 2023 Athletic Department Blog Updates

Print
GENERAL
  • After final clearance and review from the KHSAA / KMA Sports Medicine Committee last Thursday, the revised required GE04 and optional PPE01 have been published on the KHSAA website. 
  • There are notable changes on the forms this year, not only in content but in handling procedure.
  • Physicals already administered may be honored, but a revised GE04 form should (recommended but not required) be provided to parents and students to ensure the proper separation of medical records as detailed below.
  • The links to the forms are located on the KHSAA website at https://khsaa.org/general/resources/khsaa-forms/
GE04
  • Keep in mind that the GE04 form is required to be used as the parental permission and authorization for medical treatment form. This three-page form contains the information form signed by the parent and student, as well as the consent to treat. The third page of this form is the required medical clearance, which by statute, can be signed by a physician, physician’s assistant, advanced practice registered nurse, or chiropractor (if performed in the scope of practice as defined in KRS Chapter 312).
  • There is no longer an optional form for return to play from COVID-19 as those protocols have sunset.
  • The fourth page of the GE04 is a reminder on recommended records retention and schools should check with board counsel as to local requirements.
  • The information on the optional PPE01 form (if utilized) should be considered confidential medical records of the student and as such, should not be provided to non-medical personnel including coaches and athletic administrators.
  • Only the completed GE04 should be provided to coaches for the purpose of emergency authorization for medical treatment and documentation of clearance.
  • The physical expiration date (13 months from the administration date) should be recorded by the athletic administrative staff by editing the Overall Athletic Roster in the school subdomain to ensure tracking and trigger helpful alerts for renewal.
  • The GE04 is located at  https://khsaa.org/forms/ge04.pdf
PPE01
  • The information on the optional PPE01 form (if utilized) should be considered confidential medical records of the student and as such, should not be provided to non-medical personnel including coaches and athletic administrators.
  • Only the completed GE04 should be provided to coaches for the purpose of emergency authorization for medical treatment and documentation of clearance.
  • The physical expiration date (13 months from the administration date) should be recorded by the athletic administrative staff by editing the Overall Athletic Roster in the school subdomain to ensure tracking and trigger helpful alerts for renewal.
  • The optional PPE01 form has been completely updated for this year by the groups responsible for the form, including the American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine.
  • The revised form does include COVID screening questions, however, the completion of those questions (and all others) are not a requirement for athletic eligibility. Any requirement for any specific information on the form to be completed (or not completed) is a function of the medical provider administering the exam.
  • The authorized medical provider has autonomy in the review of any submitted information and the completion of the authorization to participate.
  • The English version of the optional PPE01 form is located at https://khsaa.org/forms/ppe01.pdf
COMBINED VERSION
  • There are also combined versions on the website for those that desired to distribute the entire form as a packet, and such will be provided to medical personnel around the state.
  • Schools utilizing the combined versions are reminded to adhere to the records retention cautions detailed above.
  • The English version of the combined form is located at https://khsaa.org/forms/ge04-total-requiredge04andoptionalppe01.pdf
SPANISH VERSIONS
Print


Contact Us » P:(859) 299-5472 - F:(859)-293-5999 ~ 2280 Executive Drive, Lexington, KY - 40505

HOME  |  ABOUT  |  CONTACT  |  HELP  |  
Copyright © 2024
Kentucky High School Athletic Association. All rights reserved		 khsaa
icon-angle icon-bars icon-times