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Signature of athlete Signature of parent/guardian Date -- Emergency Contact Name Relationship Phone H W Physician Section Sports athlete will participate in Baseball Golf Tennis Cross Country Hockey Height Weight Vision R 20/ L 20/ Normal MEDICAL Appearance Eyes/Ears/Throat Lymph Nodes Heart Pulses Lungs Abdomen Genitalia male only Skin Describe Abnormal Findings Football Skiing Soccer Softball Track Volleyball Swimming Lacrosse Body fat optional Corrected Y / N Abnormal Pulse BP / /...
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How to fill out preparticipation physical exam
How to fill out a preparticipation physical exam:
01
Obtain the necessary forms: Contact your school or organization to request the preparticipation physical exam forms. These forms usually include sections for personal information, medical history, and a physical examination checklist.
02
Gather relevant medical documents: Before starting the exam, collect any medical documents that may be helpful in completing the forms. This could include previous medical records, immunization history, and any notes from previous injuries or surgeries.
03
Review and complete personal information: Start by filling out the personal information section of the forms. This usually includes your name, date of birth, address, and emergency contact information. Make sure to provide accurate and up-to-date information.
04
Fill out the medical history section: This section requires you to provide details about your medical history, including any existing medical conditions, allergies, medications you're currently taking, or chronic illnesses. Be thorough and include all relevant information to ensure a comprehensive evaluation.
05
Complete the physical examination checklist: The physical examination checklist typically includes various sections such as general appearance, vital signs, cardiovascular system, respiratory system, musculoskeletal system, and more. As you undergo the physical examination, the healthcare provider will assess your overall health and mark the appropriate boxes on the checklist.
06
Follow any additional instructions: Some preparticipation physical exam forms may have additional sections or questions related to specific sports or activities. Make sure to carefully read and answer these sections, as they may be crucial in determining your eligibility or identifying any potential risks.
Who needs a preparticipation physical exam:
01
Student-athletes: Most schools and athletic organizations require student-athletes to undergo a preparticipation physical exam before participating in any sports or athletic activities. This helps ensure their safety and identifies any potential medical concerns or limitations that may affect their participation.
02
Individuals starting a new fitness regimen: If you're planning to start a new fitness program or exercise routine, it's advisable to consult with a healthcare professional and consider getting a preparticipation physical exam. This can help identify any underlying health issues that may need to be addressed before engaging in strenuous physical activities.
03
Individuals with certain medical conditions: Some medical conditions or chronic illnesses may necessitate a preparticipation physical exam, especially if the condition could potentially be aggravated by physical exertion. This allows healthcare providers to assess the individual's condition, offer appropriate recommendations, and advise on any necessary precautions.
Remember, it's important to consult with a qualified healthcare professional or your school/organization's designated medical personnel to understand specific requirements and guidelines for completing a preparticipation physical exam.
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