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Revised 7/1/05 MandatoryPreparticipation Physical EvaluationHISTORY Format of Exam Name Sex Age Date of birth Grade School Sport(s) Address Phone Personal Physician In case of emergency, contact:
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It is a form or document used to report if a doctor has ever been involved in malpractice or disciplinary actions.
Doctors, medical professionals, or healthcare institutions may be required to file has a doctor ever.
The form typically requires providing information about any malpractice or disciplinary actions taken against a doctor.
The purpose is to ensure transparency and inform patients about the professional history of a doctor.
Information such as malpractice cases, disciplinary actions, or any other relevant professional misconduct.
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