Forms

Physical Form

Concussion Form

May 2023

TO: PARENTS OF MHSA SPORTS PARTICIPANTS LICENSED MEDICAL PROFESSIONALS

FROM: BRIAN MICHELOTTI, EXECUTIVE DIRECTOR

RE: UPDATED MHSA PRE-PARTICIPATION PHYSICAL EXAM FORM

Article II, Section (3) of the MHSA Handbook requires that a physical exam must be performed for each student for that student to be considered eligible for participation in an Association Contest. Physical exams must be completed prior to the first practice. This examination must be certified by a licensed medical professional acting within the scope and limitations of his/her practice. This certification is valid for a period of one school year. A physical examination conducted before May 1st is not valid for participation for the following school year.

Logan Health, the official health care provider of the MHSA, is a new sponsor of the MHSA PreParticipation Physical Form. Parents/guardians may use the medial provider of their choice for the PreParticipation Physical Examination for their student athlete.

The MHSA Executive Board approved important additions to this form. Specifically, questions concerning the cardiac history and cardiac health of the student were added (questions 6-15), and an updated section on vaccinations which needs to be complete. This year, the two questions regarding COVID-19 have been removed.

This MHSA pre-participation form is the only form that will be allowed for the student’s exam (no other forms will be accepted). The following process should be followed:

• Parent(s)/legal guardian(s) and their student will fill out the questionnaire and history portion of the form together.

• A medical provider will review the form with the student and parent/guardian and perform the exam. A signature from the medical provider is required to clear the student for participation.

• The student and parent/guardian will sign the form.

• The completed MHSA pre-participation form physical exam will be given to the appropriate school administrator.

The MHSA is committed to the safety and health of our student activity participants and believes this new form will facilitate that objective. If you have any questions regarding the updated pre-participation examination form, please contact me.