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Por el presente certifico que seg n mi leal saber y entender toda la informaci n es verdadera y completa. Doy mi consentimiento para el intercambio de informaci n m dica entre el personal de enfermer a de la escuela y los proveedores de atenci n m dica. Firma del Padre/Madre/Tutor/Alumno emancipado Fecha Adapted in part from the Pre-participation Physical Evaluation History Form 02010 American Academy of Family Physicians American Academy of Pediatrics American College of Sports Medicine...
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