Acronyms

HCP:                    Health care provider means the physician, advanced practice nurse or physician assistant performing the physical examination.

LEA:                     Local Education Agency

NJDOE:                New Jersey Department of Education

NJDOH:               New Jersey Department of Health

PPE Form:          Preparticipation Physical Evaluation Form also known as a sports physical form. This includes the history, physical examination, and medical clearance forms.

General Application

The pre-participation physical exam, also known as the sports physical, ideally will be conducted by the student’s primary HCP in the medical home. The medical eligibility form must be reviewed and approved by the school physician before the student starts practice or participates in the sport.

The completed history and physical exam form should be maintained by the HCP completing the physical exam. It does not need to be shared with the school. The medical eligibility form is the only documentation required to be submitted to the school.

The preparticipation physical exam must be conducted by a HCP who is a licensed physician, advanced practice nurse or physician assistant and completed the student athlete cardiac assessment professional development module developed by the NJDOE.

1. What if my child does not have a medical home or primary health care provider?

Students with health insurance should have a medical home. If you do not have a medical home or health insurance notify the school nurse. The district board of education shall make accessible information regarding the NJ Family Care program to students who are knowingly without medical coverage pursuant to N.J.S.A.18A:40-34.

If a student does not have a medical home, the school district shall provide the examination at the school physician’s office or other comparably equipped facility, pursuant to N.J.S.A.18A:40-4.

2. What PPE Form is required?

The PPE Form was updated jointly by the 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, and American Osteopathic Academy of Sports Medicine in 2019 and again in 2023 and adopted for use by the New Jersey Department of Education in 2024. The NJDOE notified districts regarding the updated form in a NJDOE broadcast memo.

3. What pages of the PPE do I need to submit to the school?

The medical eligibility form is the only document that should be submitted to the school. The health history questionnaire and physical exam form should be maintained by the healthcare provider completing the physical exam.

4. Can the PPE Form be modified?

No. Pursuant to N.J.S.A.18A:40-41.7 2(a) The board of education of a public school district and the governing board or chief school administrator of a nonpublic school shall require that prior to the participation of any student enrolled in grades six to 12 on a school-sponsored interscholastic or intramural athletic team or squad, the student shall have a physical examination using the "Preparticipation Physical Evaluation" Form developed jointly by the 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, and American Osteopathic Academy of Sports Medicine. The PPE Form shall include the history and physical examination components. The PPE Form shall also include a certification statement, to be signed by the licensed physician, advanced practice nurse, or physician assistant who performed the physical examination, attesting to the completion of the current professional development module developed pursuant to subsection a. of section 3 of P.L.2013, c.71 (C.18A:40-41d).

The updated form no longer requires the submission of the health history questionnaire or the physical exam portion of the exam to the school.

5. Is there a place on the PPE Form for the physician’s stamp?

Yes. The PPE Form developed pursuant to the law does not require a physician’s stamp. However, the “clearance page” of the PPE Form has been revised to include an area for the HCP’s office stamp. The HCP performing the exam must still sign the certification for clearance and the statement attesting to the completion of the cardiac assessment module developed by the NJDOE.

6. How should LEA’s satisfy requirements set forth at N.J.A.C.6A:16-2.2(h)1.iv., which requires written notification be signed by the school physician stating approval of the student's participation be provided to parents?

As the Department is unable to further modify the PPE without amendments to the statute governing the use of the PPE, LEAs are required to develop a process and procedure for satisfying this requirement. Procedures could include developing a form letter on district letterhead disseminated to the parents. It is permissible to use an electronic signature to satisfy this requirement.

7. Does the school nurse and the school physician need to review the history and physical exam section?

No. The school physician is only required to review the medical eligibility form. This is an administrative signature verifying the healthcare provider medically cleared the student for participation and the attestation statement to the completion of the cardiac assessment module is signed. In accordance with N.J.A.C. 6A:16-2.2(h)1. iv. and N.J.A.C. 16-2.3(a)4. iv, the school physician must provide written signed notification to the parent or guardian stating approval or disapproval (and the reason for disapproval) of the student’s participation in athletics based upon the medical report.

8. Where should the medical eligibility form be kept?

The medical eligibility form should be kept in the student’s health file at school and recorded on the A-45 pursuant to N.J.A.C. 6A:16-2.4. A health record of each pupil shall be kept, in which shall be entered the findings of each examination, and such record shall be the property of the board of education and shall be forwarded to any public school to which the pupil is transferred, if such school is known (N.J.S.A. 18A:40-4).

9. Can an e-mail serve as written notification stating the school physician reviewed and approved the PPE Form?

No. N.J.A.C. 6A:16-2.2(h)1. iv and N.J.A.C. 6A:16-2.3(a)4iv require the LEA to “provide to the parent written notification signed by the school physician stating approval of the student’s participation in athletics based upon the medical report or the reasons for the school physician’s disapproval of the student’s participation.” An email notifying a parent of their student’s approval or disapproval to participate in athletics alone does not meet these requirements. However, email may be used to transmit written notification to parents of students indicating the school physician’s approval or disapproval of their participation in athletics. Once the form is signed electronically or stamped, then it may be forwarded to the parent.

10. Can forms be sent electronically?

School districts that have purchased or use a system where PPE forms are sent electronically to the school physician for review and approval are advised that the medical eligibility form may contain confidential health information and should be handled in compliance with the same confidentiality as other student education and health records. For additional information and guidance, you may wish to visit the US Department of Education’s page on protecting student privacy.

11. Is it necessary to complete and approve the required medical eligibility form before the first day of practice or tryouts?

Yes. The physical exam must be completed within 365 days of the first practice. It must be submitted, reviewed, and approved by the school physician before the student can participate. Students whose physical exam is up to date on the first day of the season (tryouts) are cleared for the entire season regardless of whether the physical exam form expires mid-season.

Parents/guardians may want to consider scheduling the exam and submitting the medical clearance before tryouts to allow time for completion of the review and approval process. Districts may set timelines and deadlines for submission to align with scheduled tryouts.

12. Does the term “physician” only mean MDs and DOs or are other individuals such as chiropractors allowed to complete physicals?

According to N.J.S.A.18A:40-1, “physician” refers to physicians licensed to practice medicine and surgery within the state. N.J.S.A.18A:40-41.7 allows licensed physicians, advanced practice nurses and physician assistants to conduct the student-athletes` pre participation physical exam. This has not changed. Since chiropractors are not licensed to practice medicine or surgery, nor are they specifically named in the law, they are not allowed to complete the physical.

13. Can a district have one general sign-off sheet for all required signatures (i.e., Sudden Cardiac Death Pamphlet, Steroid Testing Policy Consent, Sports-related Concussion and Head Injury Fact Sheet)?

No. N.J.S.A.18A:40-41 requires districts to distribute the following documents to each student-athlete and the student’s parent or guardian each year and prior to participation by the student in an athletic activity.

• Sudden Cardiac Death in Young Athletes Brochure N.J.S.A.18A:40-41.9
• Opioid Use and Misuse Educational Fact Sheet N.J.S.A.18A:40-41.10
• Sports Related Concussion and Head Injury Fact Sheet N.J.S.18A:.40-41.2

These documents, whether physically distributed or electronically disseminated, must be individually signed, and submitted. One generic signature for all documents is not acceptable. The forms are available on the NJDOE website for student athletes.  

14. What is the supplemental history form of the PPE for students with special needs?

The “Athletes with Special Needs: Supplementary History Form” of the PPE is for students who have physical disabilities due to birth injuries, genetic malformation, accidental injuries, trauma, or other causes. An athlete must first be determined to have a disability under the ADA before this form is used. This form is to be completed by the student's parent or guardian before taking the student to the HCP for the medical examination. The form is kept on file by the HCP completing the physical examination.

15. When is the Health History Update Questionnaire required?

In accordance with N.J.S.A. 18A:40-41.7 if a student’s PPE was completed more than 90 days prior to the first day of official practice in an athletic season, a health history update questionnaire is required.

16. Will additional clearances be needed if a parent denotes “yes” to one of the questions on the Health History Update Questionnaire?

The certified school nurse and athletic trainer (if applicable) are required to review the Health History Update Questionnaire. The form includes only what the law requires. However, it is the responsibility of the certified school nurse and the LEA, pursuant to N.J.S.A. 18A:40-4, to pursue appropriate follow-up for “yes” answers to determine whether medical attention is necessary and therefore, whether to delay clearance to participate in the athletic season to ensure that the student is healthy and fit to participate.

17. Does an 18-year-old student need a parent to complete the history form of the PPE Form?

Yes. Unless the student is legally emancipated, the PPE Form includes questions regarding the student and family history and the law requires the parent or guardian to complete the form and sign at the bottom of the page. This form should be completed and submitted to the HCP performing the physical examination.

18. Does the school nurse have to sign the “Health History Update Questionnaire” also known as the 90-day update indicating that he/she reviewed the form?

No. There is no requirement for the certified school nurse to sign the form. However, it is the responsibility of the certified school nurse to pursue appropriate follow-up for “yes” answers to determine whether medical attention is necessary and therefore, whether to delay clearance to participate in the athletic season to ensure that the student is healthy and fit to participate.

19. Does the HCP completing the PPE Form need to provide documentation of completing the Cardiac Assessment Training module?

No. The HCP performing the exam is only required to sign the certification statement on the PPE Form attesting to completion of the professional development module.