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Blank Fhsaa El 2 PDF Form

The FHSAA EL 2 form is a preparticipation physical evaluation required by the Florida High School Athletic Association for student athletes. This form collects essential information about a student's health history and current medical status to ensure their safety while participating in sports. It is important to complete this form accurately and submit it to the school, as it is valid for one year and must be kept on file.

To fill out the FHSAA EL 2 form, please click the button below.

Article Guide

The FHSAA EL 2 form serves as a crucial document for student-athletes in Florida, ensuring their health and safety before participating in sports. This preparticipation physical evaluation form must be completed annually and kept on file by the school for a full year from the evaluation date. It is essential for parents or guardians to provide accurate student information, including personal details and emergency contacts. The form also includes a comprehensive medical history section, where students or their guardians must answer questions regarding past illnesses, injuries, and any ongoing health issues. This section is designed to identify potential health risks that could affect a student's ability to safely engage in sports activities. Additionally, a licensed medical professional must complete the physical examination portion, assessing various aspects of the student's health, including vital signs and musculoskeletal condition. The physician's assessment determines whether the student is cleared for participation, requires precautions, or is not cleared at all. Overall, the FHSAA EL 2 form plays a vital role in promoting the well-being of young athletes and ensuring that they are fit to compete.

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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: ____/ ____/ ____

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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: ____________________________________________________________________________________

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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 –

➤ PDF File

Form Specifications

Fact Name	Description
Form Purpose	The FHSAA EL2 form is used for preparticipation physical evaluations for student athletes in Florida.
Validity Period	This form remains valid for 365 calendar days from the date of the evaluation noted on page 2.
Non-Transferable	If a student changes schools during the validity period, the form must be resubmitted.
Medical History	Part 2 of the form gathers important medical history, including past injuries and current health conditions.
Emergency Contact	The form requires the name and contact information of a person to reach in case of an emergency.
Physical Examination	A licensed physician or qualified medical professional must complete Part 3, which includes a physical exam.
Immunization Records	Students must record dates of their most recent immunizations for tetanus, measles, hepatitis B, and chickenpox.
Governing Law	The form is governed by Florida Statutes s.1006.20 and FHSAA Bylaw 9.7.
Signature Requirement	Both the student and a parent or guardian must sign the form, affirming the accuracy of the provided information.

Fhsaa El 2: Usage Guidelines

Filling out the FHSAA EL 2 form is an essential step in ensuring that student athletes are cleared for participation in sports. This form gathers important information about the student’s medical history and physical evaluation. Once completed, the form must be submitted to the school, where it will be kept on file for one year.

Obtain the Form: Download or request the FHSAA EL 2 form from your school or the FHSAA website.
Fill Out Student Information: In Part 1, provide the student’s name, sex, age, date of birth, school, grade, sports, home address, phone numbers, parent/guardian name, email, and emergency contact details.
Complete Medical History: In Part 2, answer all questions regarding the student’s medical history by circling “Yes” or “No.” If any answers are “Yes,” provide explanations in the designated area.
Record Immunization Dates: Include the dates of the student’s most recent immunizations for Tetanus, Measles, Hepatitis B, and Chickenpox.
Sign the Form: Both the student and the parent/guardian must sign and date the form, confirming that the information provided is accurate.
Schedule a Physical Examination: Arrange for a licensed physician or other qualified medical professional to complete Part 3 of the form, which includes a physical examination and assessment.
Submit the Completed Form: Once all sections are filled out and signed, submit the form to the school’s athletic department for filing.

Your Questions, Answered

What is the FHSAA EL2 form?

The FHSAA EL2 form is a Preparticipation Physical Evaluation required by the Florida High School Athletic Association. It documents a student’s medical history and physical examination to ensure they are fit to participate in sports. This form must be completed annually and kept on file by the school.

Who needs to complete the EL2 form?

All student-athletes participating in sports at Florida high schools must complete the EL2 form. This includes students in grades 6 through 12. Parents or guardians typically assist in filling out the form, particularly the medical history section.

How long is the EL2 form valid?

The EL2 form is valid for 365 calendar days from the date of the physical examination documented on the form. After this period, a new evaluation and form submission are required to continue participating in sports.

What happens if a student changes schools?

If a student transfers to a different school during the validity period of the EL2 form, they must resubmit page 1 of the form to the new school. The form is non-transferable, meaning it cannot be used at another school without this resubmission.

What information is required on the EL2 form?

The EL2 form requires various information, including the student’s name, age, date of birth, school, grade, sports participation, and emergency contact details. Additionally, it includes a comprehensive medical history section that must be completed by the student or parent.

Who performs the physical examination?

The physical examination must be conducted by a licensed physician, osteopathic physician, chiropractic physician, physician assistant, or certified advanced registered nurse practitioner. This ensures that a qualified professional evaluates the student's health and fitness for sports.

What if a student has a medical condition?

If a student has a medical condition or answers "yes" to any of the health questions, it is crucial to provide detailed explanations on the form. This information helps healthcare providers make informed decisions about the student's ability to participate in sports safely.

Are there any specific requirements for female students?

Yes, the EL2 form includes optional questions specifically for female students regarding their menstrual history. This information can be relevant for understanding their overall health and fitness in relation to sports participation.

What should parents do if they have questions about the EL2 form?

If parents have questions about the EL2 form, they should reach out to the school’s athletic department or the healthcare provider conducting the physical examination. It is essential to clarify any uncertainties to ensure the form is completed correctly.

Common mistakes

Failing to provide complete student information. Incomplete details can lead to delays or issues with eligibility.
Not updating the form after a change of schools. The form is non-transferable, requiring re-submission if the student changes schools.
Overlooking the medical history section. Providing inaccurate or incomplete medical history can impact the student’s safety during sports.
Ignoring the need for a physician's signature. This signature is crucial for validating the physical evaluation and ensuring compliance.
Not recording the dates of immunizations. These records are essential for the school’s health compliance requirements.
Failing to explain “yes” answers in the medical history section. Lack of explanation can lead to confusion or further inquiries.
Using outdated forms. The FHSAA EL2 form must be the most current version to be accepted.
Neglecting to check for allergies or chronic conditions. This information is vital for the student’s health and safety during sports activities.
Failing to keep a copy of the completed form. Retaining a copy can be useful for future reference or in case of disputes.

Documents used along the form

The FHSAA EL2 form is a critical document for student-athletes, ensuring that they undergo a thorough physical evaluation before participating in sports. In addition to this form, several other documents may be required or helpful during the pre-participation process. Below is a list of commonly used forms and documents associated with the FHSAA EL2 form.

FHSAA EL3 Form: This form is a consent and release of liability for student-athletes. It must be signed by a parent or guardian, acknowledging the risks associated with sports participation.
FHSAA EL5 Form: This document provides information about the student-athlete's health insurance coverage. It is essential for schools to verify that athletes have proper medical coverage in case of injury.
FHSAA EL4 Form: This form is used to report any medical conditions or disabilities that may affect a student-athlete's participation in sports. It helps schools accommodate students' needs appropriately.
Immunization Records: These records verify that the student-athlete has received all required vaccinations. Schools often require up-to-date immunization information to ensure the health and safety of all students.
Emergency Contact Form: This document lists emergency contacts for the student-athlete. It is crucial for schools to have this information readily available in case of an emergency during practices or games.
Health History Form: This form collects comprehensive health information about the student-athlete, including past injuries, surgeries, and chronic conditions. It aids medical personnel in understanding the athlete's health background.
Concussion Awareness Form: This document educates student-athletes and their parents about the risks of concussions. It typically requires a signature to acknowledge understanding of the information provided.
Participation Agreement: This agreement outlines the expectations and responsibilities of student-athletes and their parents regarding participation in school sports programs.
Physical Examination Report: This report is completed by a healthcare provider and summarizes the findings from the student-athlete's physical exam. It is a vital component of the pre-participation evaluation process.

These documents collectively ensure that student-athletes are physically and mentally prepared for their sports activities. Each form plays a specific role in safeguarding the well-being of the athletes while promoting a healthy sporting environment.

Similar forms

The FHSAA EL2 form serves as a critical document for student-athletes in Florida, ensuring their health and safety before participating in sports. There are several other documents that share similarities with the EL2 form, particularly in their purpose of assessing a student’s fitness for athletic participation. Below are four such documents:

Preparticipation Physical Evaluation (PPE): This document is similar to the EL2 form as it also requires a thorough medical assessment by a licensed healthcare provider. Both forms gather information about the athlete's medical history, current health status, and any potential risks associated with sports participation.
Sports Physical Form: Like the EL2, the sports physical form is designed to evaluate a student's physical condition before they engage in sports. It includes sections for medical history and physical examination findings, ensuring that students are cleared for athletic activities.
Health History Questionnaire: This document complements the EL2 form by collecting detailed health information from the student or their guardian. It focuses on past medical issues, injuries, and family health history, which are crucial for understanding the athlete's overall health and readiness for sports.
Emergency Contact Form: While not a direct health evaluation, this form is essential for ensuring that emergency contacts are readily available in case of an injury or health crisis during sports activities. It aligns with the EL2 form's goal of safeguarding student-athletes by facilitating quick communication in emergencies.

Dos and Don'ts

When completing the FHSAA EL2 form, it is essential to follow certain guidelines to ensure accuracy and compliance. Below are four recommendations on what to do and what to avoid.

Do ensure all sections of the form are filled out completely. Missing information can delay processing.
Do double-check the dates of your physical evaluation. The form is only valid for 365 days from that date.
Do provide accurate medical history. This information is crucial for the safety of the student-athlete.
Do have the form signed by a licensed physician, physician assistant, or nurse practitioner. This signature is required for validation.

Don't submit the form without reviewing it for errors. Inaccuracies can lead to complications.
Don't forget to keep a copy of the completed form for your records. This can be helpful for future reference.
Don't use the form for more than one school year. If the student changes schools, a new form must be submitted.
Don't ignore any questions about medical history. All relevant information should be disclosed for the safety of the student.

Misconceptions

Here are seven common misconceptions about the FHSAA EL2 form, along with explanations to clarify each point.

Misconception 1: The EL2 form is only needed for athletes in certain sports.

All student-athletes, regardless of the sport, must complete the EL2 form to participate in any athletic activity.

Misconception 2: Once submitted, the EL2 form does not need to be updated.

The form must be updated if there are any changes in the student’s medical condition or if the student changes schools.

Misconception 3: Parents can sign the form without any involvement from the student.

Both the student and the parent or guardian must sign the form, indicating that they have reviewed the information together.

Misconception 4: The EL2 form is valid indefinitely once completed.

This form is valid for only 365 days from the date of the physical evaluation. After that, a new form is required.

Misconception 5: Any doctor can complete the EL2 form.

The form must be completed by a licensed physician, physician assistant, or certified advanced registered nurse practitioner.

Misconception 6: The EL2 form is only for physical evaluations.

While the form includes a physical evaluation, it also collects important medical history and information about the student’s health.

Misconception 7: The EL2 form is not necessary if the student has had a recent physical for another activity.

Even if a student has had a recent physical, they must still complete the EL2 form specifically for FHSAA athletic participation.

Key takeaways

Filling out the FHSAA EL 2 form is an important step for student-athletes in Florida. Here are some key takeaways to keep in mind:

Validity Period: The form is valid for 365 days from the date of the physical evaluation.
Non-Transferable: If a student changes schools during the validity period, page 1 must be re-submitted.
Emergency Contact: It's crucial to provide accurate emergency contact information, including relationship and phone numbers.
Medical History: Parents or students should carefully answer all medical history questions, especially those marked "yes."
Physician's Role: A licensed physician or qualified medical professional must complete the physical examination section.
Signatures Required: Both the student and a parent or guardian must sign the form to verify the information is correct.
Immunization Records: Record the dates of the most recent immunizations, as this information is necessary for participation.
Gender-Specific Questions: There are optional questions for female students regarding menstrual history that should be addressed if applicable.
Assessment of Health: The physician's assessment is crucial. They will indicate if the student is cleared for sports.
Keep a Copy: Always keep a copy of the completed form for personal records, even though the school retains the original.