Section 6 (Physician’s section) of CIPPE Form

Document Type: Secton-6-of-CIPPE1 –
Instructions: This is the Comprehensive Pre-Participation Physical Evaluation as required by the State of Pennsylvania. This is section 6 – The comprehensive Pre-Participation Physical Evaluation / Certification of Authorized Medical Examiner. This document will need to be downloaded/printed and taken to a physician for signature. Once complete, it can be uploaded here, or scanned using your smartphone/tablet via the Healthy Roster App.