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    NEW INFORMATION FOR SPORTS PHYSICALS FOR 2015-2016
    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.    

Forms for Physicals - Required for Sports Participation (PDF format):