The Pre-participation examination is a well-established clinical tool used to identify student-athletes who may be at risk of adverse clinical outcomes through participation in sport. The examination is a screening tool to identify these individuals prior to participation in sports. The examination can be performed as part of a routine office visit with the student-athlete’s primary care provider, at an urgent care, or part of a mass physicals event held at a school. This chapter focuses on the latter, which is most relevant to the school nurse. To be successful, a mass physicals event requires a team, including the school nurse, athletic trainer and school physician among others. Organization and planning is key to ensure efficient and appropriate medical care is administered. The most important part of the pre-participation examination is to screen for cardiac abnormalities, based on an athlete’s medical and family history as well as examination findings.