1. Why must I (we) sign an authorization form for release of health information
about my (our) student-athlete?
Federal law, known
as the Health Insurance Portability and Accountability Act (HIPAA), prohibits health care
providers and professionals in most situations from releasing any information about a
persons health status unless the person has signed an authorization form
specifically permitting such release. If the
person whose health information is being released is a minor, a parent or guardian must
sign the authorization.
2. Why does the school need health information about my (our) student-athlete?
is necessary to evaluate the student's eligibility to
participate in organized sports programs sponsored by the school, or to participate in
physical education classes.
information about my (our) student-athlete will the school receive?
A students health information, which may be released pursuant to your signed
authorization, includes: 1) records of physical examinations performed to determine the
student's eligibility to participate in school sponsored activities; 2) the
Pre-participation Evaluation form or other similar document required by the school prior
to determining eligibility of the student to participate in classroom or other school
sponsored activities; 3) records of the evaluation, diagnosis and treatment of injuries
which the student incurred while engaging in school sponsored activities, including
practice sessions, training and competition; 4) and other records as necessary to
determine the student's physical fitness to participate in classroom or school sponsored
4. How will this information be used
by the school?
The school needs the information to make decisions about the student's health and ability
to participate in certain school sponsored and classroom activities, which require
physical activity. The students
health information will not be used for any other purpose unless you sign another
authorization form permitting such additional use.
the school disclose this information to anyone outside the school system?
Once the school receives the students health information from the health care
provider, that information becomes subject to the Family Educational Rights and Privacy
Act (FERPA), and further disclosures are limited by federal law. You can find out more about FERPA at www.ed.gov/policy/gen/guid/fpco/ferpa/index.html.
6. What if a parent refuses to sign the authorization?
In accordance with OHSAA rules, the school shall not allow the student to
participate in interscholastic athletics.
How many times will this authorization need to be signed?
The authorization form is valid for the duration of the students enrollment in the
I revoke the authorization at any time?
Yes, but such revocation must be in writing and sent to the school principal or designee. Note that such revocation will only apply to uses
of the students health information after the date of the revocation. When such revocation is received by the school
administrator, the student-athlete will no longer be eligible for participation in