Preparticipation Eval Form.pdf

1. Athlete Information: Includes name, date of birth, grade, sex assigned at birth, and sport(s) participated in.
2. Patient Health Questionnaire: Assesses mental health, including anxiety, worry, and depression.
3. Medical History: Inquires about past and current medical conditions, surgeries, medications, and allergies.
4. General Questions: Asks about concerns, previous denials or restrictions from sports participation, and ongoing medical issues.
5. Heart Health Questions: Investigates heart-related issues, including fainting, chest pain, and family history of heart problems.
6. Bone and Joint Questions: Examines history of stress fractures, bone, muscle, ligament, or joint injuries.
7. Medical Questions: Covers various medical topics, including respiratory issues, organ removal, skin rashes, concussions, and vision problems.
8. Female-Specific Questions: Inquires about menstrual history and eating habits.
9. Athletes with Disabilities Form: A supplement for athletes with disabilities, covering type of disability, assistive devices, and special needs.

Key Components:

Athlete and parent/guardian signatures
Date of examination
Explanation of "yes" answers to certain questions
Permission for non-commercial, educational reprinting with acknowledgment

Organizations:

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
American Osteopathic Academy of Sports Medicine

Year: 2023-2024