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PARTICIPATION PHYSICAL EVALUATION HISTORY FORM (NOTE: THIS FORM IS TO BE FILLED OUT BY THE PATIENT AND PARENT PRIOR TO SEEING THE PHYSICIAN. THE PHYSICIAN SHOULD KEEP A COPY OF THIS FORM IN THE CHART

How to fill out pre-participation physical evaluation history

1. Start by reviewing the pre-participation physical evaluation form provided by your organization or healthcare provider.
2. Gather relevant medical information, such as any previous surgeries, illnesses, or injuries, as well as any ongoing medications or treatments.
3. Provide accurate personal and contact information, including your name, address, phone number, and emergency contact details.
4. Provide details about your medical history, including any chronic conditions, allergies, or family history of medical conditions.
5. Be thorough in reporting your prior injuries or surgeries, ensuring to include dates, medical providers, and any ongoing treatment or follow-up.
6. Answer questions about any medications you are currently taking, including dosage and frequency.
7. Discuss any past or current medical conditions or illnesses, such as asthma, diabetes, or heart problems.
8. Indicate any known allergies, whether they are environmental, food-related, or medication-related.
9. Mention any dietary restrictions or special healthcare needs.
10. Provide information about your exercise and physical activity habits, including any sports or activities you regularly participate in.
11. Sign and date the form, acknowledging that the information provided is accurate and complete to the best of your knowledge.
12. Remember that the pre-participation physical evaluation history may be required for various purposes, such as participating in sports, joining a gym, or starting a new job or program that requires a health assessment.
13. Anyone who is planning to engage in physical activity or participate in certain programs, such as school sports, college athletics, or military training, may need to fill out a pre-participation physical evaluation history form. This is done to ensure that individuals are in good health and do not have any underlying medical conditions that may put them at risk during physical activity.
14. Athletes of all ages, from children to adults, may need to fill out a pre-participation physical evaluation history to participate in organized sports or competitions.
15. Individuals entering certain professions that require physical fitness, such as firefighters or law enforcement officers, may need to provide a pre-participation physical evaluation history as part of their job application process. This helps ensure that they can safely perform the physical requirements of the job.
16. Colleges and universities often require students to submit a pre-participation physical evaluation history before participating in organized sports or physical education courses.
17. It is important to consult with your healthcare provider or organization to determine if you need to fill out a pre-participation physical evaluation history and what specific information should be included. Each organization may have different requirements and forms.

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What is pre-participation physical evaluation history?

Pre-participation physical evaluation history is a form that documents an individual's medical history to assess their readiness to participate in physical activities.

Who is required to file pre-participation physical evaluation history?

Student athletes and individuals participating in certain sports or activities may be required to file pre-participation physical evaluation history.

How to fill out pre-participation physical evaluation history?

Pre-participation physical evaluation history is typically filled out by providing accurate information about past medical conditions, surgeries, medications, allergies, and family history.

What is the purpose of pre-participation physical evaluation history?

The purpose of pre-participation physical evaluation history is to identify any medical conditions that may affect an individual's ability to safely participate in physical activities.

What information must be reported on pre-participation physical evaluation history?

Information such as medical history, surgeries, medications, allergies, family history of medical conditions, and current health status must be reported on pre-participation physical evaluation history.