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Signature of Health Practitioner Revised 5-2010 June 2012 License Number Office Phone Number Date Revised 4-25-2013. FORM D -- Health Practitioner please refer to the letter references provided on Form C. NIAA PRE-PARTICIPATION PHYSICAL EVALUATION PHYSICAL EXAMINATION NAME HEIGHT / VISION R 20/ DATE OF EXAMINATION BODY FAT optional MEDICAL Appearance Eyes/Ears/Nose/Throat Lymph Nodes Lungs Abdomen Genitalia Males Only Skin CARDIOVASCULAR Murmur that Increases From Supine to Standing Systolic...
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Formd--healthpractitionerpleaserefertoformletterampreferencesprovidedonformc is a form used for medical practitioners to refer patients to specific letters and references provided on the form.
Health practitioners are required to file formd--healthpractitionerpleaserefertoformletterampreferencesprovidedonformc.
Formd--healthpractitionerpleaserefertoformletterampreferencesprovidedonformc can be filled out by providing the necessary information about the patient and referring to the specific letters and references on the form.
The purpose of formd--healthpractitionerpleaserefertoformletterampreferencesprovidedonformc is to facilitate the referral process for patients by health practitioners.
On formd--healthpractitionerpleaserefertoformletterampreferencesprovidedonformc, information about the patient and specific letters and references must be reported.
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