Millions of children participate in sports and physical activities. To ensure safe participation during practice, competition, and general physical activity the AAP encourages youth to receive a preparticipation evaluation (PPE) (often called a “sport physical”) as part of their routine health supervision visit. The information on these pages can help pediatricians understand the impact PPEs have on children's lives.
Preparticipation Evaluation Overview
The authoring organizations recommend that the PPE be conducted in the medical home during the annual health supervision appointment by the individual’s primary care provider. The PPE should be conducted at least 6 weeks before the first preseason practice to allow time to evaluate the individual and treat any medical conditions found during the visit. If group-based examinations away from the medical home are performed as a community service for those individuals without a medical home and/or health insurance, a process should be in place to help these individuals establish a medical home.
The frequency of a PPE is determined by the state. Learn more about your state PPE law.
The goals of the PPE are:
- Promote optimal and safe physical activity.
- Provide a framework to assess, promote, and discuss physical and psychological health related to physical activity in conjunction with the annual health supervision visit.
- Encourage use and/or establishment of a medical home for continuity-based health care.
- Identify conditions that may be life-threatening or disabling, or those that may predispose to injury or illness related to physical activity.
- Provide an opportunity for discussion of health and lifestyle issues.
AAP Recommendations
The Preparticipation Evaluation (PPE), 6th Edition serves as a resource for medical providers to keep individuals safe and healthy while participating in sports and physical activities. It provides helpful guidance on the appropriate timing, setting, frequency and structure of the evaluation to support the health and wellbeing of participants and includes practical tips for implementation in clinical practice. The book details the history, physical examination, and medical eligibility considerations, while providing guidelines for determining medical eligibility and return-to-play decisions. It also addresses the medicolegal and ethical issues that healthcare providers may encounter in practice. It is available for purchase on shopAAP.
The Preparticipation Evaluation, 6th Edition was developed 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 the American Osteopathic Academy of Sports Medicine. It is also endorsed by the American Heart Association, National Athletic Trainers’ Association and the National Federation of State High School Associations.
What’s New in the 6th Edition
- New content on Preventing and Addressing Abuse and Sexual Violence; Cancer Survivors; Sports Nutrition and Dietary Supplements; and Implementation of the PPE in Clinical Practice
- Expanded content on Mental Health and Individuals with Disabilities
- Streamlined History and Physical Examination Forms
- Expanded and user-friendly Medical Eligibility Form to be shared with the schools.
- The title has been changed from Preparticipation Physical Evaluation to Preparticipation Evaluation to reflect the fact that the screening encompasses much more than a physical examination. It involves a comprehensive history, family history, and medical record review.
- The 6th edition is no longer called a monograph. This term was appropriate when the first edition was published in 1992; however, the current work is more properly called a book, as it includes hundreds of pages of critical information and resources.
- The 6th edition has prioritized inclusiveness for all individuals, as the benefits of physical activity are universal. Child, family, societal, and financial barriers to participation need to be addressed by examiners to help reach the goal of inclusion in either sports (including competitive, adaptive, or therapeutic) or recreational activities.
Qualifications of the Examiners
Depending on state law, the PPE examination is conducted by an MD, DO, nurse practitioner or physician assistant with clinical training to evaluate and determine medical eligibility of the participant on a broad range of health issues.
Forms
Forms are available to download. Please contact [email protected] if forms will be integrated into an EHR.
Medical History Forms
We encourage individuals and their parent/guardian to fill out a medical history form together before the examination. The medical history form includes standard elements important to consider in evaluating the patient’s eligibility to participate in sports and activities. The medical history form, physical evaluation form, and medical clearance form are available as downloadable forms in English and Spanish.
The primary care provider should review the medical history in a private setting with the individual and their guardian and again in private with the individual alone should there be any confidential information the individual would like to discuss.
A supplemental history form is also available to help support participation in physical activities for Individuals with Disabilities. Please note this form should not be used in place of the Special Olympics form.
If the individual is participating in the Special Olympics, please use:
Special Olympics Medical Form Special Olympics Medical Form Instructions Special Olympics Article 1 Sports Rules (appendix E)
Physical Examination Form
The PPE physical examination form guides primary care providers in conducting a system-based examination to include cardiovascular, nervous system, general medical conditions, respiratory system, gastrointestinal and urogenital, dermatological, musculoskeletal and mental health. Group examinations in school locker rooms or gymnasiums are strongly discouraged as they do not provide the participant with a confidential space for the PPE and providers do not have access to the individual’s medical records. A PPE performed in a clinical setting is protected by HIPAA, which means consent is required for sharing the PPE with non-medical school staff. A PPE performed at a school or non-clinical setting is not protected by HIPAA. It is protected by FERPA, which means that school staff can access a student’s PPE paperwork without consent.
Screening Tests
Routine screening tests are not recommended (e.g. labs, EKG). In some situations, diagnostic tests may be necessary based on findings from the history and/or physical examination.
Medical Eligibility Form
When determining medical eligibility, the primary care provider should have experience in evaluating individuals and determining if they are medically able to participate in sports and physical activities. Shared decision making is appropriate and recommended in many situations.
After the examination, the primary care provider can find the individual:
- Medically eligible for all sports and activities without restrictions
- Medically eligible for sports and activities without restriction, with recommendations for further evaluation or treatment
- Medically eligible AFTER evaluation and clearance
- Medically eligible for certain sports and activities
- Not medically eligible for any sports or activities
The medical eligibility form is the ONLY form that should be submitted to nonmedical personnel at a school or sports organization. The PPE writing group has developed a revised and easier to use standard medical eligibility form in the 6th edition that will provide the necessary information for medical personnel at the school while staying compliant with both FERPA and HIPAA
For More Information
The 6th edition PPE book includes additional guidance and resources and is available for purchase on shopAAP.
Podcasts and Voices Blogs
Learn what others are saying. Listen to our podcasts and read our blog posts.
Return to Sports Guidelines - Episode 49
Hosts David Hill, MD, FAAP, and Joanna Parga-Belinkie, MD, FAAP, talk to Susannah Briskin, MD, FAAP, lead author of the AAP Covid-19 Guidance: Return to Sport, about infection prevention during youth sports and safely returning to physical activity after recovering from COVID-19.
Pediatrics on Call
|March 9, 2021
Last Updated
09/17/2026
Source
American Academy of Pediatrics