TL;DR
- Purpose: The health history form is the most important part of the sports physical and most providers just glance over it. Going through it line by line — with the athlete AND a parent in the room — is how you find the things that actually change your clearance decision.
- First question to ask: Is there anything in this history that I need to understand better before I sign?
- Don’t miss:
- New or undiagnosed murmur / family history of early cardiac death: Don’t clear. Refer to cardiology for EKG (with or without echo) before they practice or play.
- Exertional SOB or palpitations: Very low threshold to send to cardiology. Take your time getting a good history on these kids.
- Seizure history: Well-controlled epilepsy is generally cleared for contact sports as long as they have a clearance letter or prior documented clearance from their neurologist. Seizure history in a swimmer needs further workup and strict precautions.
- Wrestler with a skin finding: Most states require a separate skin form. Tinea corporis, impetigo, molluscum all disqualify athletes until it’s treated.
- Active injury under another provider’s care: That provider needs to clear them separately for that injury.
- The rule: Teens are not reliable historians. Go through the form out loud, with a parent present, and ask follow-up questions. The history will tell you almost everything you need to know.
- In the app: When something flags mid-visit and I’m not sure where it lands, I’ll ask Blox IQ for clearance criteria before I make a call.
Summer is primetime for sports physicals. Most of the time, these are healthy-looking kids with parents who are juggling sports, summer camps, vacations and doctors appointments and are just trying to get a signature before the first practice of the season.
It’s really easy to get into a rhythm where you scan their intake and sign the form, but actually clearing these patients is really important and can have some serious implications if you miss something.
It’s also important to realize that what matters for a baseball player is different from what’s important for a wrestler (or swimmer or soccer player). The conversation I’d have with a swimmer who has a seizure history is different from the one I’d have with a cross-country runner with the same history. If you’re not letting the sport inform the exam (and your final decision to clear or not clear), you’re doing the patient a disservice and opening yourself up to liability.
Here are a few areas where you really need to slow down.
The Health History Form
This is the most important part of the visit, and many providers just scan it and move on.
Every state has its own version (in Tennessee where I practice, it’s the TSSAA form), but they all cover the same ground: cardiac history, neurologic history, musculoskeletal injuries, current meds, family history. The form IS your history and should be the framework for your visit. You go through it line by line with the athlete AND the parent in the room. Children (especially teens), are not reliable historians and they will often – intentionally or unintentionally – omit important information.
This is by far the longest part of these visits but it’s the most important and will tell you 90% of what you need to know.
Cardiac
This is the category that matters most.
A new or undiagnosed murmur or family history of unknown or cardiac cause under 50 gets my attention. Those kids go to cardiology for an EKG and possibly an echo. Most times, they end up with a normal workup and are cleared, but you don’t need to be the one making that call.
Exertional symptoms are also a very low threshold referral for me. Excessive shortness of breath, palpitations, or near-syncope with exercise all get referred to cardiology. Yes, most of us get out of breath or feel like our heart is racing when we are really exerting ourselves. This is where you have to take a few extra minutes to really dig into whether what the athlete experiences is typical or concerning. If they say “yes” to these questions, it doesn’t mean something is wrong. But my job (and yours) isn’t to decide if it’s clinically insignificant, it’s to get them to the person who can tell them that it is.
For patients with vague symptoms or history, it can feel like overkill to send them to cardiology before they are cleared. But the potential implications are too serious for you to determine that in a quick visit.
Concussion History
If an athlete has had prior concussions and they’re currently asymptomatic, I clear them for participation. What I’d encourage you to do (especially if you don’t work in sports medicine) is refer them to a sports medicine provider for a longer conversation about return-to-play and cumulative risk, particularly if they play a contact sport. That conversation is really outside the scope of what this visit is designed to do, but it’s one that needs to happen at some point.
Asthma
Athletes with known, well-controlled asthma typically get cleared. I make sure to document that they need to have their rescue inhaler accessible on the sideline.
If the history sounds suspicious for exercise-induced asthma (for example wheezing, excessive fatigue during exercise) but there’s no diagnosis yet, send them to their pediatrician for PFTs before you sign off.
Seizure History
This one really depends on the sport.
Well-controlled epilepsy is generally cleared for contact sports as long as the patient has prior, documented clearance from their neurologist. The AAP supports participation in football, wrestling, and basketball with appropriate precautions. Where it gets more complicated is anything involving water (swimming, water polo, etc.). A kid with seizure history joining the swim team needs a very detailed conversation about supervision, never being in the water alone, and what the team’s emergency plan looks like if something happens. It’s not an automatic no but it’s not a routine clearance either.
This is one history component where the sport really changes the risk.
Vision
For most sports, poor vision isn’t a hard stop. For athletes with 20/40 vision or worse, I clear but refer to optometry.
The exception to this would be a patient who has true monocular vision. One functional eye means they need to wear protective eyewear appropriate for the sport and they’re generally out on full-contact sports like wrestling, football, or boxing.
Wrestlers and the Skin Form
Most states require a separate skin clearance form specifically for wrestling which will tell you what the criteria is for clearance. For most, tinea corporis, impetigo, and molluscum contagiosum mean they need to be out until it’s treated and documented as resolved.
Active Injuries Under Another Provider
If your patient is actively being managed somewhere else for an injury or recent surgery, that provider needs to clear them. You don’t have the full picture and you’re not in a position to make that call. Document that clearance is deferred (or they are cleared with Provider X’s approval) and move on.
Make It Part of How You Work
And honestly, a lot of this comes down to the form. If you’re actually going through it thoroughly with every athlete, the flags will come up. Most of these kids will have zero health history and normal exams, but from time to time, you’ll find things that you can’t miss.
One of the biggest things I can encourage you to do is to treat that form as the actual exam, not just routine intake paperwork. Go through it with them out loud, with a parent present, and ask detailed follow up questions.