Basic physical exam forms printable

    • [PDF File]PRE PARTICIPATION PHYSICAL FORM MEDICAL HISTORY FORM …

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      MRI, CT, surgery, injections, rehabilitation, physical therapy, a brace, a cast, or crutches? If yes, circle below Head Neck Shoulder Upper arm Elbow Forearm Hand/ Fingers Chest Upper back Lower back Hip Thigh Knee Calf/ Shin Ankle Foot/ Toes 20 Have you ever had a stress fracture? 21 Have you been told that you have or have you had an x-ray for atlantoaxial (neck) instability? 22 Do you regularly use a …

    • [PDF File]BASIC SCREENING PHYSICAL EXAMINATION

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      Patient Centered Medicine 2 ii. At the same time, inspect skin of the upper extremities for turgor, texture, pigmentation, and skin lesions. Describe all skin lesions (macule, papule, vesicle, pustule, nodule). Note any subcutaneous lesions (rheumatoid nodule, ganglion cyst, lipoma).

    • [PDF File]ANNUAL PHYSICAL EXAMINATION FORM - Health & Wellmobile

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      PHYSICAL EXAMINATION FORM . Name: Date of Exam: Address: Date of Birth: Sex: Male Female DIAGNOSES/SIGNIFICANT HEALTH CONDITIONS CURRENT MEDICATIONS (Attach a second page if needed): Medication Name Dose Frequency Diagnosis Prescribing Physician Specialty Date Medication Prescribed

    • [PDF File]Athletic Physical Form

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      athletic physical form, athletic physical exam form, physical exam, physical examination, athletic physical, physical form, athletic, physical Created Date 8/13/2010 9:43:08 AM

    • [PDF File]Pre-Employment History and Physical Form

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      Have you ever had: a car accident loss of consciousness heart attack loss of vision abnormal heart rhythm seizure panic attacks head injury stroke paralysis back injury psychiatric disorder Current Medical Conditions Those that you are currently experiencing and/or receiving tr eatment for (such as diabetes, high blood pressure, migraine) Please List Date of onset (mo/yr) Please List Date of onset (mo/yr) 1 / 5 …

    • [PDF File]PRE-EMPLOYMENT HISTORY AND PHYSICAL

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      to a physical examination and such tests consistent with the job description and the physical requirements necessary for the position for which I am seeking employment. Date _____ Signature of Applicant _____ PLEASE DO NOT WRITE IN THE SECTION BELOW

    • [PDF File]9-20 ANNUAL PREPARTICIPATION PHYSICAL EXAMINATION

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      ARIZONA INTERSCHOLASTIC ASSOCIATION. 7007 N. 18TH ST., PHOENIX, ARIZONA 85020-5552 PHONE: (602) 385-3810. The Preferred Urgent Care of the Arizona

    • [PDF File]CERTIFICATE OF MEDICAL EXAMINATION Form Approved …

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      physical fitness testing and medical examinations as a condition of their employment.€ The primary use of this information will be to determine the nature of a medical or physical condition that may affect safe and efficient performance of the work described.€ Additional potential routine uses of this information include using it to ensure fair and consistent treatment of employees and job applicants, to adjudicate …

    • [PDF File]ChiLD & ADOLEsCEnThEALT h ExAMinATiOn FORM Print Clearly - …

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      Does the child/adolescent have a past or present medical history of the following? M Asthma (check severity and attach MAF): M Intermittent M Mild Persistent M Moderate Persistent M Severe Persistent M If persistent, check all current medication(s): Quick Relief Medication M Inhaled Corticosteroid Oral Steroid Other Controller None Well-controlledAsthma Control Status M M Poorly Controlled or Not …

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