Part A, Medical History, is filled out by parent / guardian.
Part B: Physical Exam Medical Staff Assessment, completed by licensed independent practitioner: Doctor-Dr., Nurse Practitioner-NP, Physician's Assistant-PA.
Sports Physical: valid for 1 year from date indicated below.
Disclosure: information is voluntary; however, if information is not provided, individuals may not be able to participate in community activities.
Routine uses: no information is disclosed outside DOD.
| Question | Answer |
|---|---|
| Form Name | HASPS |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 6 min |
| Edition | Revised 12Jan 10 |
| Other names | HASPS, CYS sports physical, CYS health assessment form, Health Assessment / Sports Physical Statement |
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