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IT'S ANNUAL PHYSICAL TIME! Please call to schedule your child's exam today. 785-543-5211

Please see the details below. If you need the physical forms, you can download here or can pick up at the Medical Clinic.

Dear Parent or Guardian:

The Medical Staff at Phillips County Medical Clinic is pleased to offer a complete well-child examination that will encompass the school physical for your child. However, these physicals must be scheduled directly with the Medical Clinic. Please call the Medical Clinic at (785) 543-5211 to secure a time that works for both you and your child. Please do this at the earliest opportunity so that we can get the physical completed BEFORE it is needed for any summer activities.

The school physical form has been revised by Kansas State High School Activities Association, from 4 pages to 5 pages in the gathering of more complete medical information with/on your child. A ‘fast-track’ physical is no longer sufficient. With the added components, along with the Concussion & Head Injury Form, a more complete well-child examination is very important for the following reasons:

● Ensure that your pre-teen and teenager are developing healthfully, inside and out. There will be discussions about nutrition, exercise, good health habits, and how to avoid risky behaviors.

● Help prevent potential health problems because many illnesses begin BEFORE your child looks or feels sick. A health checkup can identify potential health problems that may require early screening or intervention.

● Wellness exams encourage teens to take responsibility for his or her own health. Teens can speak to their Provider one-on-one, which frees them up to privately ask their own health-related questions and, therefore, become more vested in their health and well-being.

● Information presented is more tailored around the specific needs of your tween and teen. In the age of social media and online searches, it is all too easy to get information and self-prescribe. By developing this relationship with your child’s provider, you can be assured of getting the best care tailored to your child’s specific needs.

● Collaboration with the PCHS physical therapy department, at the time of your physical, to address any Musculoskeletal (scoliosis, etc.) findings that could be addressed at the visit or worked into their scheduling. Also, most insurance companies are acknowledging the importance of a wellness visit in cost savings to them down the road and these visits are reimbursing 100% of the allowable fee for this visit. However, if you do not have insurance, please call Patient Accounts and discuss other options available.

Please prepare for your child’s appointment by:

♦ Complete Pages 1 and 2 of the Pre-Participation Physical Evaluation (PPE). This should be completed with both the parent/guardian and child’s participation and signed by both student-athlete and parent/guardian.

♦ Complete Page 4 - Shared Emergency Information and the parent/guardian consent and signature.

♦ Complete Page 5 – Attention Parents and Students: KSHSAA Eligibility Checklist. Both the parent/guardian and the student must also sign Page 5.

♦ Complete the enclosed Concussion & Head Injury Information Release Form. This form MUST BE signed by both the parent/guardian and student-athlete and brought to the appointment.

♦ A parent/guardian is required to attend an appointment with any child under the age of 18.

♦ Your child’s immunization history will be reviewed. Please be prepared with his/her immunization record.

♦ Bring your insurance cards with you, as well as, driver’s license, if applicable.

We look forward to partnering with you and your school in your child’s health and wellness. Please call, as soon as possible, to secure a date and time that works for both you and your child.

**If you schedule between now and August 1st, 2021, your child will receive a complimentary insulated cooler.**

Please plan on an hour for the appointment. If your child has a valid driver’s license and can drive to the appointment by him or herself, verbal consent from the parent/guardian is all that will be required. If you have any additional questions or concerns, please do not hesitate to contact the Clinic, (785) 543-5211.

2021-2022 Physical Forms


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