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Kawameeh Middle School

 
 
The health care provider that does your sports physical must complete the Student-Athlete
Cardiac Assessment Professional Development Module, or the school cannot accept the
physical exam. Please share this information with your health care provider, and make sure
that the provider signs the certification statement on page four of the physical exam packet.
If this is not signed, the physical cannot be accepted, and will be returned to the student.

TO: Health Care Providers Performing Student Sports Physicals
SUBJECT: Student-Athlete Cardiac Assessment Professional Development Module

The New Jersey Department of Education (NJDOE) is pleased to announce the availability of the
Student-Athlete Cardiac Assessment professional development module (PD module) required by
the Scholastic Student-Athlete Safety Act (SS-ASA) (N.J.S.A. 18A:40-41.7). The PD module can
be found at
http://www.state.nj.us/education/students/safety/health/services/athlete/PDModule.shtml.
 
The SS-ASA requires that:

• The PD module be completed by the physician, advanced practice nurse (APN), or physician
assistant (PA) who performs a student-athlete’s annual physical examination prior to the
student’s participation on a school-sponsored interscholastic or intramural athletic team or squad
in grades six through 12 (N.J.S.A. 18A:40-41.7);

• Upon performing a physical examination, the physician, APN or PA shall sign the certification
statement on page four of the Pre-Participation Physical Evaluation (PPE) form attesting to the
completion of the PD module. The physical exam packet can be viewed at
http://www.state.nj.us/education/students/safety/health/records/athleticphysicalsform.pdf
(N.J.S.A. 18A:40-41d);

During the summer, please bring your completed physicals to UHS Main Office, so they can be
processed immediately. Do not send them to Kawameeh Middle School because the School
Nurse will not get them until school starts again in September.