Q1. Where should the date of the physical examination be recorded on the PPE form?

A. The date of the physical exam is required at the top of page one, page two (if being used), and the
bottom of pages three and four of the PPE. The PPE is intended to be completed and signed by
the HCP at the date/time that the medical examination is conducted.

Q2. When do the new PPE forms go into effect?

A. The new forms went into effect on April 29, 2014. The NJDOE notified districts in a Broadcast
memorandum which can be viewed at http://education.state.nj.us/broadcasts. (Select April 29,
2014, then scroll down to the Scholastic Student-Athlete Safety Act for more information.)

Q3. Where do we include information on the PPE about ongoing medical conditions, such as
diabetes?

A. The “History Form” of the PPE asks if the student has any ongoing medical conditions and
includes diabetes, in Question #2

Q4. Are physical examinations performed in July and August compliant under the new rules?

A. Yes, the new PPE became mandatory on April 29, 2014.

Q5. Is the PPE required prior to the first day of practice or the first day of tryouts?

A. The law requires that the PPE be completed prior to the first official practice session of the
athletic season.

Q6. How does the PPE address checking for scoliosis or a hernia?

A. Although there are no questions specific to scoliosis and hernia, the HCP who conducts the
examinations will include observations for hernias when examining the student’s abdomen and
groin. Similarly, the HCP would evaluate for scoliosis when examining the student’s back and
musculoskeletal system. In addition, scoliosis screening is mandated for students ages 10 through
18 in New Jersey, according to N.J.A.C. 6A:16-2.2(k)4

Q7. Where can the parent/guardian or HCP indicate on the PPE form the student has asthma
or a life-threatening allergy that requires epinephrine?

A. The “History Form” of the PPE provides an area for the parent/guardian in the box titled
“Medicines and Allergies” to provide information on allergies and a checkbox under “General
Questions” to indicate asthma. The “Physical Examinations Form” of the PPE provides space, as
well, to document asthma under “Lungs/Abnormal Findings.” Allergies, including life-threatening
allergies requiring epinephrine, and asthma may also be indicated on the “Clearance
Form” of the PPE under “Recommendations and Comments.” Moreover, in New Jersey, school
districts must follow the specific statutory and regulatory requirements for asthma treatment plans
for students with asthma and individualized health plans and individualized emergency health
plans for all students with life-threatening allergies. Those plans are already a part of the
student’s health record and do not need to be duplicated in the PPE.

Q8. Does the term “physician” only mean MDs and DOs or are other individuals such as
chiropractors allowed to complete physicals now?

A. 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-athlete’s preparticipation physical
evaluation. 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
physicals.

Q9. 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)?

A. No. N.J.S.A. 18A:40-41(d) requires each student-athlete and the student’s parent or guardian
each year and prior to participation by the student in an athletic activity, sign and return to the
student’s school the form developed by the commissioner pursuant to the Scholastic Student-Athlete
Safety Act. Therefore, the sign-off sheet cannot be combined with other required sign-off
sheets.

Q10. Can the Sudden Cardiac Death in Young Athletes pamphlet be collected by coaches along
with other required forms such as the code of conduct, HIB form, Steroid Testing Consent
form, etc.?

A. The Sudden Cardiac Death in Young Athletes pamphlet must be distributed to each
student-athlete and completion of athletic permission forms, pursuant to N.J.S.A. 18A:40-41(d).
The student-athlete and the parent or guardian may keep the pamphlet. The student-athlete and the parent or
guardian must certify in writing that they received and reviewed the pamphlet. The coach may
choose to collect the Sudden Cardiac Death in Young Athletes signed certification in the same
manner as the other sign-off sheets. The sign-off sheet for the pamphlet can be accessed at
https://www.nj.gov/education/safety/health/athlete/index.shtml.

Q11. Can the Preparticipation Physical Evaluation (PPE) form be modified?

A. Pursuant to the law, school districts and nonpublic schools shall require that, prior to participation
of any student in grades six to12 on a school-sponsored interscholastic or intramural athletic team
or squad, the student shall have a physical examination using the PPE form jointly developed by the
American Academy of Family Physicians, American Academy of Pediatrics, American College of
Sports Medicine, American Medical Society for Sports Medicine, American
Orthopedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine
(developers). Since the law mandates that this specific PPE form be used, the form may not be
modified by an individual school district or nonpublic school, pursuant to N.J.S.A. 18A:40-41.7.

Q12. Is there a place on the PPE form for the physician’s stamp?

A. The PPE form developed pursuant to the law does not require a physician’s stamp. However, the
“Clearance Form” of the PPE has been revised to include an area for the health care provider’s
office stamp, if required by your district.

Q13. Can the font size on the PPE form be increased?

A. The Department will pursue development of a form with a larger font size.

Q14. Can the NJDOE add a line for the school physician to sign that he/she reviewed it?

A. N.J.A.C. 6A:16-2.2(h)1iv and N.J.A.C. 6A:16-2.3(a)3iv require the school district to “provide
written notification to the parent or guardian of the student-athlete 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.” The law does not
require the signature of the school nurse or school physician on the PPE form. However, the
“Clearance Form” of the PPE has been revised to include an area for the school physician to add
his/her signature, if required by your district.

Q15. Do you foresee a Spanish translation of the “History Form” of the PPE in the near future?

A. Yes, the Spanish “Health History Form” is available online at
http://www.nj.gov/education/students/safety/health/records/.

Q16. What is the supplemental history form of the PPE for students with special needs?

A. 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. This form is to be completed by the parent or guardian of the student prior to
taking the student and PPE to the HCP for the medical examination.

Q17. On the “Athlete’s with Special Needs: Supplemental History Form” of the PPE, question
number 7 regarding special braces and question number 10 regarding visual impairments
are confusing. Do anterior cruciate ligament (ACL) braces, sport-specific braces, or contact
lenses and glasses qualify under the special needs category?

A. The “Athletes with Special Needs: Supplementary History Form” of the PPE is for students with
physical disabilities. The Americans with Disabilities Act (ADA) defines a disability as
impairment that limits a major life activity. Types of disabilities include, but are not limited to,
cerebral palsy, deafness, paralysis, and amputation, as well as other disabilities that affect
multiple systems such as autoimmune-mediated arthritis, muscular dystrophy, and multiple
sclerosis. An athlete must first be determined to have a disability under the ADA before this form
is used. When a student with a disability is using an ACL brace as part of the recovery phase
from an injury or surgery, the brace is not included in question number 7. If a student with a
disability has a visual impairment that limits major life activities even with corrective glasses or
contact lenses, that would be noted in question number 10.

Q18. Why is the Health History Update Questionnaire now 90 days out?

A. The new legislation requires that if a student’s PPE was completed more than 90 days prior to the
first day of official practice in an athletic season that an updated health history is required.

Q19. Will additional clearances be needed if a parent denotes “yes” to one of the questions on the
Health History Update Questionnaire?

A. 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
certified school nurse’s and school physician’s responsibility, 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 in order to
ensure that the student is healthy and fit to participate.

Q20. Does an 18 year old student need a parent to complete the history form of the PPE?

A. 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 of the
PPE and sign at the bottom of the page.

Q21. Does the school nurse have to sign the “Health History Update Questionnaire” indicating
that he/she reviewed the form?

A. No. There is no requirement for the certified school nurse to sign the form. The certified school
nurse reviews the Health History Update Questionnaire and documents it on the students health
record (A-45) pursuant to N.J.A.C. 6A:16-2.3(b)3iii.

Q22. How will the NJDOE notify HCP’s that are not in New Jersey about the requirement to
complete the PD module?

A. The NJDOE will notify all appropriate professional organizations and State agencies when the
PD module is available. Additionally, as required by the legislation, the PD module will be
posted on websites of the NJDOE, the American Academy of Pediatrics-NJ Chapter, the New
Jersey Academy of Family Physicians, the American Heart Association, the American College of
Cardiology-NJ Chapter, the Athletic Trainer’s Society of New Jersey, New Jersey State Board of
Medical Examiners, New Jersey State Board of Nursing, and the New Jersey State Society of
Physician Assistants. In addition, the New York, Pennsylvania and Delaware State Boards of
Medical Examiners will be notified.

Q23. When will the Student-Athlete Cardiac Screening PD module be available for HCP’s to
complete?

A. The NJDOE notified districts in a Broadcast memorandum on March 10, 2015 of the availability
of the PD module. The memo included guidance around the implementation of this requirement
and can be viewed at https://www.education.state.nj.us/broadcasts. (Select March 10, 2015, then scroll
down to the Student-Athlete Cardiac Assessment Professional Development Module for more
information. The PD module is available at https://www.nj.gov/education/students/safety/health/services/athlete/PDModule.shtml.

Q24. Will HCP’s receive CME or CNE credits upon completion of the PD module?

A. No. The NJDOE does not have the capacity to provide continuing medical education credit or
continuing nurse education credits since NJDOE does not belong to the American Nurses
Credentialing Center or the American Medical Association credentialing division

Q25. Can a student participate in a school-sponsored athletic event or activity if the vision
screening was not conducted by the HCP at the time of the preparticipation physical
evaluation?

A. The “Physical Examination Form” of the PPE requires documentation of vision screening. If the
medical provider did not perform a vision screen during the examination, according to N.J.A.C.
6A:16-2.2(h)1ii4, “An incomplete form shall be returned to the student’s medical home for
completion unless the certified school nurse can provide documentation to the school physician
that the missing information is available from screenings completed by the certified school nurse
or physician within the prior 365 days.”

Q26. Does the school nurse and the school physician still need to review the PPE?

A. The certified school nurse is responsible for maintaining student health records, in accordance
with N.J.A.C. 6A:16-2.3(b)3iii. Therefore, in order for the certified school nurse to record the
medical examination on the student’s health record (A-45), she/he must review it, as well as
document significant findings, such as referral for follow-up of medical conditions, new
medications, or new allergies, etc.
In addition, the school physician will also need to review the PPE, in accordance with N.J.A.C.
6A:16-2.2(h)1iv and N.J.A.C. 16-2.3(a)3iv, as the school physician must provide written
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

Q27. Does the HCP need to complete and sign the bottom of page three and page four of the PPE
since both pages include clearance sections?

A. Yes. The HCP is required to review the “History Form” of the PPE (page 1) and “Athletes with
Special Needs: Supplementary History Form” of the PPE, if applicable (page 2), conduct the
medical examination, complete page three of the “Physical Examination Form” of the PPE, and
then sign at the appropriately designated signature line. The fourth page, the “Clearance Form”
of the PPE, allows additional space for the HCP to document findings and comments. In
addition, the HCP is required to attest to the completion of the PD module by providing his/her
signature a second time on the “Clearance Form” of the PPE.