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DO NOT FOLD FORM UNIVERSITY OF MISSISSIPPI MEDICAL CENTER/UNIVERSITY SPORTS MEDICINE ATHLETIC PARTICIPATION FORM Please Print Name Date School Grade Sport s Sex M F Date of Birth S.S.N. Age Parent/Guardian Name Work Phone Address Home Phone Family Physician Work Phone FAMILY MEDICAL HISTORY Yes No Has any member of your family under age 50 had these conditions Condition Whom Heart Attack Sudden Death Stroke Heart Disease / High Blood Pressure Diabetes Sickle Cell Anemia Arthritis Epilepsy...
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How to fill out mississippi sports physical form
How to fill out Mississippi sports physical form:
01
Begin by obtaining a copy of the Mississippi sports physical form. This form can often be found on the website of the Mississippi High School Athletic Association or by contacting the appropriate school or sports organization.
02
Carefully read all instructions provided on the form. It is crucial to understand the necessary information and requirements before proceeding.
03
Start by filling out the personal information section. This typically includes the athlete's name, date of birth, address, phone number, and emergency contact information. Ensure that all information is accurate and up to date.
04
Move on to the medical history section. Here, you will be asked to provide details about any existing medical conditions, previous injuries, surgeries, allergies, and current medications. Answer each question honestly and thoroughly.
05
If applicable, complete the section for the athlete's primary care physician. Include the physician's name, address, and phone number.
06
Proceed to the next section, which typically requires the athlete to undergo a physical examination. This portion must be completed by a licensed healthcare provider, such as a doctor, physician assistant, or nurse practitioner. Schedule an appointment with the healthcare provider and ensure that they are aware of the specific requirements outlined in the form.
07
During the physical examination, the healthcare provider will assess various aspects of the athlete's health, including vision, hearing, heart, lungs, abdomen, musculoskeletal system, and overall fitness. The provider will then document their findings on the form, including any necessary recommendations or restrictions for sports participation.
08
Once the physical examination is complete, review the form to ensure all sections have been filled out accurately and completely. Make any necessary corrections, if applicable.
09
Finally, sign and date the form, indicating your consent and agreement to the information provided. In some cases, a parent or guardian may also need to sign the form, especially for minor athletes.
Who needs Mississippi sports physical form:
01
The Mississippi sports physical form is typically required for any individual wishing to participate in organized sports activities within the state.
02
This may include students in middle school or high school, as well as individuals participating in community or recreational sports leagues.
03
Coaches, athletic directors, and sports organizations often require this form to ensure the safety and well-being of the athletes.
04
It is essential to check with the specific school or sports organization to confirm their individual requirements and deadlines for submitting the completed form.
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How to fill out mississippi sports physical form?
The Mississippi Sports Physical Form can be filled out using the following steps:
1. Enter the patient’s name, address, and date of birth.
2. Enter the patient’s height, weight, and blood pressure.
3. Answer all medical history questions, including any current or past medical conditions, medications, and allergies.
4. Sign and date the form.
5. Have the form signed and dated by a physician.
6. Submit the form to the school or organization requiring it.
What is the purpose of mississippi sports physical form?
The Mississippi Sports Physical Form is used to provide medical clearance for student athletes to participate in sports activities. The form provides medical information about the athlete and helps ensure that the student is medically capable of participating in the sport of their choice.
What information must be reported on mississippi sports physical form?
The Mississippi sports physical form must include information about the participating athlete, such as name, date of birth, address, parent/guardian contact information, medical history, immunization records, and any prior injuries or illnesses. The form must also include a signed consent from the parent/guardian and a physical examination report by a qualified medical professional.
What is mississippi sports physical form?
The Mississippi sports physical form, also known as the Pre-Participation Evaluation (PPE) form, is a document that is required for student-athletes in Mississippi to participate in school sports activities. This form includes medical information such as the athlete's medical history, previous injuries, current medications, and any existing medical conditions. It also includes a physical examination conducted by a licensed healthcare professional to assess the athlete's overall health and fitness for participating in sports. The completed form is typically submitted to the school or sports organization before the start of the sports season.
Who is required to file mississippi sports physical form?
In Mississippi, student-athletes at both the middle school and high school level are typically required to file a sports physical form. This form is usually required before participating in any school-sponsored athletic activities.
What is the penalty for the late filing of mississippi sports physical form?
The specific penalty for the late filing of a Mississippi sports physical form may vary depending on the policies of the school or sports organization involved. It is recommended to consult with the school or sports organization directly to determine their specific penalties or late filing policies.
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