Printable physical forms
[DOCX File]Physical Exam Form - Pennsylvania Department of Health
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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.
[DOC File]History and Physical Exam Form
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Physical Health Exam Periodically Cholesterol Screening Every 5 years. Men beginning at age 35, Women at age 45. Pap Smear (F) Every 1-3 years to age 65 Mammogram (F) Every 1-2 years, over age 49 Breast exam (F) Every 1-2 years PSA (M) At clinician's discretion Sigmoidoscopy Every 3-5 years after age 19 Glaucoma Blacks - ages 20-45 every 3-5 ...
[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
[DOC File]Full H & P - CALTCM
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NURSING HOME ADMISSION HISTORY AND PHYSICAL FORM. 2 . Title: Full H & P Subject: SNF Last modified by: HP_Administrator Created Date: 4/9/2004 8:33:00 PM Other titles: Full H & P ...
[DOC File]Fitness Goal Setting Form - 110% FIT
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Increasing physical activity is safe for most people. However, some individuals should check with a physician before they become more physically active. Completion of this questionnaire is a first step when planning to increase the amount of physical activity in your life.
[DOC File]OSHA Respirator Medical Evaluation Questionnaire
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OSHA Respirator Medical Evaluation Questionnaire (Mandatory) (Appendix C to Section 1910.134) Modified Form for Use with N95 Respirator ONLY (Note to the Employer: Answers to questions in Section 1, and to question 9 in Section 2 of Part A do not require a medical examination.)
[DOC File]source document template - VA Portland
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these templates are for Pis and their study coordinators and should be used as examples or templates to build from and modify to meet their specific needs. Source document templates include inclusion/exclusion worksheet, adverse event tracking log, medications log, missed visit, early withdrawal form, study visit form, randomization form, study procedures form, physical evaluation form ...
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