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Revised 7/1/05 Mandatory Preparticipation Physical Evaluation HISTORY FORM Date of Exam Name SexAgeDate of birth GradeSchoolSport s AddressPhone Personal Physician In case of emergency contact Explain Yes answers below. Circle questions you don t know the answers to. Yes No 1. Has a doctor ever denied or restricted your participation in sports for any reason 2. Do you have an ongoing medical condition like diabetes or asthma 3. Are you currently taking any prescription or nonprescription...

How to fill out physical evaluation form

How to fill out preparticipation physical evaluation history:

1. Obtain the necessary forms from the organization or healthcare provider conducting the evaluation.
2. Read the instructions carefully to understand what information is required.
3. Begin by providing your personal information, such as name, date of birth, and contact details.
4. Fill in your medical history, including any past illnesses, surgeries, or chronic conditions you may have had.
5. Provide details of any current medications you are taking, including dosage and frequency.
6. Answer questions regarding your family medical history, such as any genetic conditions or diseases that run in your family.
7. Disclose any known allergies or adverse reactions to medications or substances.
8. Indicate any previous injuries, fractures, or concussions you have experienced.
9. Describe your exercise habits, including the types of sports or activities you participate in and the frequency of your physical activity.
10. Provide information related to your immunization history, including the dates of your most recent vaccinations.
11. If applicable, document any specific concerns or issues you would like the healthcare provider to address during the evaluation.
12. Review the completed form for accuracy and make any necessary corrections before submitting it.

Who needs preparticipation physical evaluation history:

1. Athletes participating in organized sports, such as high school or college athletes.
2. Individuals enrolling in fitness programs or competitions that require a physical examination.
3. Individuals joining certain occupations that necessitate a physical evaluation for clearance, such as police officers or firefighters.

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What is preparticipation physical evaluation history?

Preparticipation physical evaluation history is a documented assessment of an individual's medical history and health status before engaging in sports or physical activities. It typically includes information about past injuries, illnesses, and any conditions that may impact participation.

Who is required to file preparticipation physical evaluation history?

Athletes and participants in school sports, recreational leagues, and competitive sporting events are typically required to file preparticipation physical evaluation history. It is often mandated by schools, sports organizations, and governing bodies to ensure safety.

How to fill out preparticipation physical evaluation history?

To fill out preparticipation physical evaluation history, individuals should complete a questionnaire that includes personal health information, family medical history, previous injuries, surgeries, and any current health concerns. This should be done carefully and accurately, often with the assistance of a healthcare provider.

What is the purpose of preparticipation physical evaluation history?

The purpose of preparticipation physical evaluation history is to identify any medical conditions or risk factors that may affect an individual's ability to participate in sports safely. It helps ensure that participants are healthy and fit for physical activity and promotes injury prevention.

What information must be reported on preparticipation physical evaluation history?

Information that must be reported on preparticipation physical evaluation history includes personal medical history, family history of medical issues, allergies, current medications, previous surgeries, and any significant past injuries or health concerns related to physical activity.