If you've moved between states as an athletic director — or if you've simply tried to look up what forms your program is required to use — you've run into a frustrating reality: there is no single national standard for pre-participation physical evaluations. The federal government sets FERPA requirements for how student health records must be handled, but the actual content of physical forms, what a physician must certify, and how long clearance remains valid are all determined at the state level. Every state athletic association has its own requirements, and some are significantly more detailed than others.
This matters operationally. Using an outdated form, a form from another state, or a generic health history form instead of the required state form creates compliance gaps that can come back to the program during an audit or after an injury. Understanding what your state requires — and how it differs from the national baseline — is foundational to running a compliant clearance program.
The national baseline: NFHS and the PPE monograph
The National Federation of State High School Associations (NFHS), in collaboration with major medical organizations, publishes the Pre-Participation Physical Evaluation (PPE) monograph — a standardized framework for what a sports physical should include. This document covers the cardiovascular history screening that became especially prominent after high-profile sudden cardiac death cases in young athletes, musculoskeletal history, neurological history, and a general health inventory.
The NFHS PPE form is a reasonable starting point, but it is not a state requirement in itself. State athletic associations may require their own specific form (which may be based on the PPE but modified), accept the NFHS form, or have their own entirely separate documentation. The NFHS form is a floor, not a ceiling — and for many states, it's not even the required floor.
What typically varies by state
Across state athletic associations, these are the most commonly varying elements:
- Form specificity. Some states publish a specific required form that must be used — no substitutions. Others specify the content that must be covered but allow programs to use any form that meets those requirements. Knowing which category your state falls into is the starting point.
- Physical validity period. Many states require an annual physical — clearance obtained in April of one school year does not carry forward to the following August. Others permit a physical to remain valid for 12 months from the exam date, which may allow a late-school-year physical to cover the start of the following year's fall sports season. Some states permit a multi-year physical with an annual update form.
- Who can perform the examination. All states require a licensed healthcare provider to conduct the exam, but the specific provider types vary. Most states accept MDs, DOs, nurse practitioners, and physician assistants. Some states restrict clearance authority to physicians only. A clearance signed by a provider type your state doesn't recognize is not a valid clearance.
- Cardiovascular screening requirements. Following advocacy from cardiac screening organizations, some states have implemented enhanced cardiovascular screening requirements — including electrocardiogram (ECG) recommendations or additional family history documentation — beyond the standard history and auscultation. These vary significantly and continue to evolve.
- Concussion baseline testing requirements. An increasing number of states now require documented baseline concussion testing as part of athletic participation. Return-to-play protocol documentation requirements also vary by state and continue to tighten as awareness of CTE and repeated head trauma has grown.
- Sickle cell trait disclosure. Following NCAA and NFHS guidance, some states now require documentation of sickle cell trait status or a signed waiver declining testing. Requirements differ by state athletic association and sometimes by school classification level.
How to find your state's current requirements
The authoritative source for your state's physical form requirements is your state athletic association — not a third-party website, not a platform's form library, and not what you remember from a prior school or state. Requirements change, and what was accurate three years ago may not be current.
Every state has a high school athletic association affiliated with the NFHS. Most publish their required forms, form deadlines, and physical validity rules in the eligibility section of their website. The document you're looking for is usually titled something like "Pre-Participation Physical Examination Form" or "Sports Physical Clearance Form" and is typically available as a PDF download directly from the association's eligibility or forms page.
If you have a new athletic trainer or sports medicine partner, verify that they are using the current version of your state's form — not a form from a previous state they worked in or a prior version that has since been updated.
Digitizing state forms without losing required content
One legitimate concern about moving to a digital clearance platform is whether the digitized form still satisfies your state's requirements. Generic digital forms tools often require you to manually recreate forms field by field — and there's real risk that something gets left out or formatted in a way the state wouldn't recognize as equivalent.
FormVault's AI Smart Form Scanning addresses this directly. You upload the official PDF or a clear photo of your state's required physical form, and the AI maps every field, section, and signature line automatically. The digitized form mirrors the required content exactly — it doesn't create a substitute form, it creates a digital version of the form you're required to use. Before each season, download the current form from your state athletic association and upload it to ensure your form library is using the current version. This takes under five minutes and ensures your digital workflow is using the same form a paper-based program would use.
The FormVault 60-day free trial includes full access to AI Smart Form Scanning. If you're unsure whether your current form setup is using the right version of your state's form, this is a direct way to start fresh with confidence.