NEW FORMS FOR YOU & YOUR HEALTHCARE PROVIDER
The State of New Jersey has provided new forms to be completed when having your child’s physical completed. Please read the information below carefully and share this with your health care provider, as there are significant changes from what has been required in the past.
- The Pre-Participation Physical Evaluation (PPE) - is a packet including six documents detailed below. Completion of these forms is required for all freshmen, and all student athletes, with medical evaluations conducted only by a licensed physician, advanced practice nurse (APN) or physician assistant (PA) who has completed the Student Athlete Cardiac Assessment professional development module as part of their ongoing training. It is recommended that you verify that your medical provider has completed this module before scheduling an appointment for your child’s physical exam.
- The PPE packet forms are available on our website holyspirithighschool.com under both the Nurses tab and the Athletics tab. They include:
- Health History Form
- The Athlete with Special Needs Supplemental History Form
- Physical Examination Form
- Clearance Form
- Sudden Cardiac Death in Young Athletes Pamphlet
- Sudden Cardiac Death in Young Athletes Pamphlet Sign Off
- A parent/guardian must complete the History Form, as well as The Athlete with Special Needs: Supplemental History Form, if applicable. Please remember to insert the date of the actual physical on both forms.
- IMPORTANT HEALTH CARE PROFESSIONAL INFORMATION: Upon completing the physical, the licensed physician, APN, or PA must sign the certification statement on the PPE form attesting to their successful completion of the Student Athlete Cardiac Assessment professional development module.
- Holy Spirit must receive an original signature of their certification on the Clearance Form to attest to their qualification as a licensed physician, APN or PA to perform the PPE.
- If the certification statement is not signed, the PPE cannot be accepted and athletes will NOT be able to participate in any sport.
- Please note: an original signature is required. Photocopied or stamped signatures are not permitted.
- The licensed physician, APN or PA who performs the physical examination must complete and insert the date of the examination on the Physical Examination Form and the Clearance Form.
- The Sudden Cardiac Death in Young Adults Pamphlet must be reviewed by both the parent/guardian and the student athlete, and the Sudden Cardiac Death in Young Adults Pamphlet Sign Off must be signed by both the parent/guardian and the student, and remain on file with Holy Spirit High School.
Holy Spirit High School will provide written notification to the parent/guardian, signed by the school nurse and/or Athletic Trainer to indicate approval of the student’s participation in a school-sponsored interscholastic athletic team based on review of the medical report. If not approved, the school will provide the reason(s) for the disapproval of the student’s participation.
The safety, health and wellness of your children are of utmost importance. Thank you for giving your prompt attention to these new certifications and forms. Should you have any questions, please call Mrs. McCusker in the Main Office at 609-646-3000 x335 who will help direct your question.