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Generic Sports Physical Form

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Sports Phys Sports Phys Sports Phys Sports Physii i ca ca i ca call l Exam Exam l Exam Exam ii i nat nat i nat natii i on on ... reviewed the above questions with my son or daughter and I give permission for my child to undergo the Preparticipation Physical Examination and to participate in sports Please Specify: Hea ...

Sports Qualifying Screening Evaluation

Nebraska School Activities Association School Sports Qualifying Screening Evaluation Please Complete in Ink INSTRUCTIONS FOR ... In the past, the two-part NSAA pre-participation physical form included (1) a page of ... This form is very "generic" and can be easily modified to fit ...

Preparticipation Physical Evaluation

Explain "Yes" answers below. Circle questions you don't know the answers to. Yes No 1. Has a doctor ever denied or restricted your participation in sports for any reason?

SPORTS QUALIFYING PHYSICAL EXAMINATION

2011- 2012 sports qualifying physical examination clearance form sports qualifying physical examination

PHYSICAL EXAMINATION FORM

PHYSICAL EXAMINATION FORM OPERATOR'S NAME HOME ADDRESS CITY STATE ZIP PHONE (Please print) First Middle Last SOCIAL SECURITY # Asthma Kidney Tuberculosis Diabetes Nervous Stomach Rheumatic Fever Over the counter drug use HEALTH HISTORY DATE OF BIRTH AGE / / ( Month / Day / Year ) IF ...

HISTORY FORM

... American Orthopaedic Society for Sports Medicine, ... ´ü« ´ÇáPreparticipation Physical Evaluation PHYSICAL EXAMINATION FORM (The physical examination must be performed on or after April 1 by a Physician holding an unlimited license to practice medicine to be valid for the following school year ...

Sports Physical Form

Sports Physical Form Name: _____ Gender: M F Date of Birth: ___/___/___ Father's Name: _____ Daytime phone, pager, cell phone: _____ Mother's Name: _____ Daytime, phone, pager, cell phone ...

Preparticipation Sports Examination

Microsoft Word - PHYSICAL EXAM FORM _3_.DOC. ... Have you ever been taken out of or kept from participating in a sports activity or practice for an injury or physical reason?

Sports Pre-Participation Physical Exam Medical History

Athlete's Name: School: Sports Pre-Participation Physical Exam Medical History Yes No Don't Know. Examination Athlete's Name: SS# Age WT (Minimum WT HT Vision (R) 1. BP) (L) 2.

PRE-PARTICIP ATION PHYSICAL EVALUATION

KANSAS STATE HIGH SCHOOL ACTIVITIES ASSOCIATION PO Box 495, 601 SW Commerce Place; Topeka, KS 66601-0495; (785) 273-5329 PRE-PARTICIP ATION PHYSICAL EVALUATION Name* * Sex* Age* Date*of*birth HISTORY *1.***Have*you*had*a*medical*illness*or*injury*since*your*last* check*up*or*sports*physical ...