KSHSAA Pre-Participation Physical Evaluation Form – NEW VERSION!

KSHSAA Pre-Participation Physical Evaluation Form – NEW VERSION!

The KSHSAA pre-participation physical exam form has been updated based on the most recent edition of the PPE: Preparticipation Physical Evaluation, 5th Edition publication. The updated edition was developed by the American Academy of Pediatrics and other supporting organizations.

We request Kansas medical providers administering this exam begin using this new form which can be found at Physical Form

Medical Eligibility PageThis is the biggest change to be aware of regarding the new form. This is a new page at the end of the PPE paperwork that requires a second signature from the healthcare provider AND the parent/guardian. This page contains the student-athlete clearance, and parental consent for participation and emergency treatment. For a PPE to be valid when submitted to the student’s school, healthcare providers are now required to sign two different places on the form (page 3 and page 4).

Signature Requirements:  Healthcare providers must provide 2 signatures. Page 3 (physical exam page) and page 4 (medical eligibility page) both require the provider’s signature.Parents/guardians must provide 3 signatures. Page 2 (health history page), page 4 (medical eligibility page) and page 5 (eligibility checklist).A cover/instruction page is included with the PPE form outlining the requirements for each entity involved with this process. The current KSHSAA PPE form can always be found on the KSHSAA website at the above address.