Physical for sports form
[DOCX File]Shaw Athletics
https://info.5y1.org/physical-for-sports-form_1_9417a6.html
To the Examining Physician: Please review the student-athletes history and complete the physician’s form. Please comment on all positive answers. The information supplied will be used as a background for providing health care. This information is strictly for Sports Medicine and will not be released without the students consent.
[DOCX File]Junior Athletes Sports Physical - Gettysburg College
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Sports Physical Form for Junior Year Athletes – Due back by July 1. Student Health CenterGETTSYBURG COLLEGE300 N. Washington StreetGettysburg, PA 17325. Phone: 717-337-6970. Fax: 717-337-6978. Dear Students: In an effort to encourage the best health and safety for our athletes, the Gettysburg College Health Service and Athletic Department requires that …
[DOC File]Preparticipation Physical Examination/Medical History for ...
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THE UNIVERSITY OF WEST ALABAMA REVISED 7/10/03 RMH MEDICAL HISTORY & PRE-PARTICIPATION PHYSICAL EXAMINATION FORM DATE: / / Athlete’s Month Day Year Name: Sports(s): (Last) (First) (Middle) (Nickname) Social Security No: / / Date of Birth: / / / / Month Day Year Age Sex Race Student No: / / Classification: Fr. So. Jr. Sr. Red Shirt Sr. (Different than …
[DOC File]TMA/TSSAA PREPARTICIPATION MEDICAL EVALUATION FORM
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The OrthoOne Sports Medicine Team will be glad to help refer your child to a Cardiology specialist at your request. Parent/Guardian: Please initial one or both of the following statements and sign below. Your initials and signature are required for completion of the physical …
[DOCX File]Microsoft Word - Preparticipation Physical Form-0511
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Page 1 of 2, Physical Examination Record & Parent’s/Guardian’s Release is on the reverse side. PHYSICAL EXAMINATION RECORD (To be completed by a licensed medical professional as designated in Article VII. ... Microsoft Word - Preparticipation Physical Form …
[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.
ELK GROVE UNIFIED SCHOOL DISTRICT - SPORTS PHYSICAL
(use reverse of form if needed): PARENT / GUARDIAN’S . AUTHORIZATION: I authorize a physician or duly authorized and supervised physician’s assistant or nurse practitioner to perform a Sports Physical Evaluation on the student. The information set forth above is complete and accurate and I know of no reason why the student cannot fully and ...
[DOC File]SPORTS QUALIFYING PHYSICAL EXAMINATION
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Reference: Preparticipation Physical Evaluation (5th Edition): AAFP, AAP, ACSM, AMSSM, AOSSM, AOASM; 2019. 2019-2020 SPORTS QUALIFYING PHYSICAL HISTORY FORM. Minnesota State High School League. Note: Complete and sign this form (with your parents if younger than 18) before your appointment.
[DOC File]Xavier University
https://info.5y1.org/physical-for-sports-form_1_73fc57.html
XAVIER CLUB SPORTS PHYSICAL. Student Name_____ Date _____Time_____ Date of Birth_____ Gender M F
[DOC File]Preparticipation Physical Examination/Medical History for ...
https://info.5y1.org/physical-for-sports-form_1_46bff4.html
MEDICAL HISTORY & PRE-PARTICIPATION PHYSICAL EXAMINATION FORM DATE: / / Athlete’s Month Day Year Name: Sports(s): (Last) (First) (Middle) (Nickname) Social Security No: / / Date of Birth: / / / / Month Day Year Age Sex Race Student No: / / Classification: Fr. So. Jr. Sr. Red Shirt Sr. (Different than Social Security No.) e-Mail Address(es): Local Apartment,
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