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Permission is granted to reprint for noncommercial educational purposes with acknowledgment. HE0503 New Jersey Department of Education 2014 Pursuant to P. Preparticipation Physical Evaluation HISTORY FORM Note This form is to be lled out by the patient and parent prior to seeing the physician. The physician should keepa copy of this form in the chart. L.2013 c.71 9-2681/0410 THE ATHLETE WITH SPECIAL NEEDS SUPPLEMENTAL HISTORY FORM 1. Type of disability 2. List the sports you are interested in...
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