Sports physical

Template

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Cardiac historyChoose any

Cardiac examChoose any

ScreensChoose any

Concussion historyChoose one

ClearanceChoose one

FormsChoose any

Follow-upChoose one

Counseling

Discussed hydration, heat illness prevention, protective equipment, and avoiding energy drinks and performance supplements. Stop and report any chest pain, fainting, or trouble breathing with exercise, and any head injury, right away. Caregiver expressed understanding and agreement with plan. Answered all questions.

Note when inserted as is

Sports physical
• No exertional chest pain, syncope, unexplained shortness of breath, or palpitations, and no family history of sudden unexplained death before age 50 or inherited heart disease
• Normal cardiac exam supine and standing, with normal femoral pulses and no Marfan features
• No history of concussion
• Cleared for all sports without restriction
• Sports participation form completed
• Follow up at the next well child check

Discussed hydration, heat illness prevention, protective equipment, and avoiding energy drinks and performance supplements. Stop and report any chest pain, fainting, or trouble breathing with exercise, and any head injury, right away. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Cardiac screening history (exclusive negative)
Concussion history

Sources

This template was built from clinical practice; no source is linked yet.

Few formal guidelines cover this topic, so the template also leans on expert opinion.