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[DOC File]SAMPLE LETTER TO HEALTH DEPARTMENT
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SAMPLE LETTER TO HEALTH DEPARTMENT. Sponsor Name Street City, State Zip Code. Date Health Department Contact, Title . Name of Health Department. Street City, State Zip Code
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[DOC File]History and Physical Exam Form
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Five (or more) of the symptoms present during the same 2-week period, a change from previous functioning and at least one of the symptoms is either depressed mood or loss of interest/pleasure may represent an episode of depression Tuberculosis Screening Review social and medical history and results of physical examination.
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[DOC File]Family Practice History and Physical
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Title: Family Practice History and Physical Author: Paul M. Henderson, MD Last modified by: user Created Date: 5/8/2003 2:49:00 PM Other titles: Family Practice History and Physical
generic health physical form

[DOC File]PATIENT HISTORY FORM - Hopkins Medicine
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general nervous system psychiatric ( Recent weight gain; how much____ ( Headaches ( Depression ( Recent weight loss: how much____ ( Dizziness ( Excessive worries ( Fatigue ( Fainting or loss of consciousness ( Difficulty falling asleep ( Weakness ( Numbness or tingling ( Difficulty staying asleep ( Fever ( Memory loss ( Difficulties with sexual ...
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[DOCX File]Physical Exam Form - Department of Health Home
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Adapted in part from the Pre-participation Physical Evaluation History Form; ©2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine.
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NAME [Patient Name]
Risk factors and disease prevention; RISK FACTORS REVIEWED. Diet. Exercise. Safety (seat belts, smoke detectors, firearms, violence) Smoking. Alcohol and other drugs
general physical examination form

fitness for duty - Human Resources
Indicate the exact work restrictions which apply to the employee at this time on the chart on the back of this form. (Complete this section if the employee is being released to modified duty.) PHYSICAL EXAMINATIONS FULL. RESTRICTIONS PARTIAL. RESTRICTIONS NO. RESTRICTIONS Sedentary-Lifting 0 to 10 pounds Light-Lifting 10 to 20 pounds
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[DOC File]PARTICIPANT REGISTRATION/RELEASE FORM
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EVENT REGISTRATION/RELEASE FORM. ... I acknowledge that motorcycle activity is a potentially hazardous activity which can be a test of a person’s physical and mental limits and carries with it the potential for death, serious injury and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature ...
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General physical form printable