The State of New Jersey recently enacted new sports physical guidance which we, the undersigned New Jersey School Nurses, believe puts our students at risk.

In the past, it has been common for us to receive sports physicals without vitals or vision being assessed by the completing physician because "they don't check that" or vital signs recorded fall outside of the accepted normal range with students still being cleared to play without follow up recommended. Additionally, the majority of students don't have their physicals completed by a medical home, and instead they are completed by an urgent care or pharmacy minute clinic. This is not because they don't have a medical home, but in the overwhelming majority of the time, it is due to the convenience of the parent. Who will be responsible for ongoing review and maintenance of those records?

The school is often the second line of defense in ensuring appropriate follow up/clearance to cardiac issues, orthopedic problems, etc.  Our school doctors have in the past uncovered serious diagnoses requiring follow-up that would not have been found without review of pages one, two, and three of the sports physical. Additionally, it has been a common occurrence for providers to  not include important information like diabetes and life threatening allergies on what was formerly page four. There is no reason to assume they will suddenly remember to include it on the new Preparticipation Physical Evaluation Medical Eligibility Form.

Additionally, on the physical exam page is the following statement to the physician completing the assessment, "Consider reviewing questions on cardiovascular symptoms (Q4–Q13 of History Form)". The recommendation from the American Academy of Pediatrics states:

      - All children should be evaluated for conditions predisposing to SCA and SCD in the course of routine health care.

      - A thorough and detailed history, family history, and physical examination are necessary to begin assessing SCA and SCD risk.

Why is the review of these questions listed as "to be considered" rather than being a requirement, especially for our student athletes?

Lastly, the new Preparticipation Physical Evaluation Medical Eligibility Form does not require a physician office stamp, making it all but assured that there will be a number of parents who complete this form on their own without any input from a medical provider whatsoever.

It is clear that while current, practicing school nurses were consulted in the creation and implementation of this new plan, their feedback was not valued or taken into consideration. We hope the State will reconsider the implementation of these forms, as they have the potential to have a significant negative impact on our student athletes.