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PARTICIPATION PHYSICAL EVALUATION 20192020 SCHOOL YEAR To be completed by the Parent: STUDENT NAME:DOB: AGE: GENDER: HOME ADDRESS: SCHOOL:GRADE:SPORT(s):FATHER/GUARDIAN NAME: MOTHER/GUARDIAN NAME:

How to fill out 125a-c preparticipation physical evaluation

How to fill out 125a-c preparticipation physical evaluation

1. Start by obtaining the necessary form, which is the 125a-c Preparticipation Physical Evaluation form.
2. Read the instructions on the form carefully before filling it out.
3. Fill out the personal information section, including your name, date of birth, address, and contact information.
4. Provide information about your medical history, including any past injuries, surgeries, or medical conditions.
5. Answer the questions about your family medical history, such as any family history of heart disease or other hereditary conditions.
6. Complete the section on allergies, listing any allergies you have and any medications you are currently taking.
7. Fill out the section on medications, including any prescription medications or over-the-counter drugs you are currently taking.
8. Provide information about your immunizations, including the dates of your most recent vaccinations.
9. Answer the questions about your physical activities and exercise habits.
10. Complete the section on the review of systems, indicating any current symptoms or concerns.
11. If applicable, have your healthcare provider fill out the section on medical clearance.
12. Review the completed form to ensure all information is accurate and legible.
13. Sign and date the form, and make a copy for your records.
14. Submit the form to the appropriate authority or organization as required.

Who needs 125a-c preparticipation physical evaluation?

1. Anyone participating in certain activities or sports may need to undergo a 125a-c Preparticipation Physical Evaluation.
2. This may include students participating in school sports programs, individuals joining a fitness program, or athletes competing in organized sports events.
3. The specific requirements and regulations regarding who needs this evaluation may vary depending on the organization or institution involved.
4. It is important to check with the relevant authority or organization to determine if a 125a-c Preparticipation Physical Evaluation is required.

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