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Physical Examination (To be completed by physician) Date: Name: Blood Pressure: Vision: R 20/ BEEN Cardiac Lungs Skin Abdominal Genitalia Upper Extremity Joint Lower Extremity Joints Spine & Musculature
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How to fill out preparticipation physical examination medical history:

01
Start by obtaining the necessary forms: Contact the appropriate authority or organization to obtain the preparticipation physical examination medical history form. This form may vary depending on the specific requirements of the organization or activity.
02
Read the instructions carefully: Before filling out the form, carefully read the instructions provided. This will help ensure that you provide all the necessary information and complete the form correctly.
03
Personal information: Begin by filling in your personal information, such as your name, date of birth, contact information, and any other required identifying details. This helps ensure that your medical records are accurately attributed to you.
04
Medical history: Provide detailed information about your medical history. This may include any past or current medical conditions, surgeries, medications, allergies, and immunizations. Be honest and accurate when answering these questions as it is crucial for your healthcare provider to have a comprehensive understanding of your medical background.
05
Family history: Indicate any relevant family medical history, such as a family history of heart disease, diabetes, or other hereditary conditions. This information can help identify any genetic predispositions that may affect your health.
06
Medications and supplements: List any medications or supplements you are currently taking, including dosage and frequency. This information allows healthcare providers to be aware of any potential interactions or adverse effects.
07
Allergies: Include any known allergies, such as allergies to medications, foods, or environmental factors. This is important information for healthcare providers to be aware of in case of an emergency or when prescribing medication.
08
Previous injuries: Mention any previous injuries or hospitalizations related to sports or physical activities. This information helps healthcare providers assess your overall fitness and identify any areas of concern.
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Additional instructions: Be sure to follow any additional instructions provided on the form. This may include signatures from parents or guardians for minors, along with any required accompanying documentation or certifications.

Who needs preparticipation physical examination medical history?

Preparticipation physical examination medical history is typically required for individuals participating in organized sports, physical activities, or certain professions that involve physical exertion. This may include student-athletes, recreational sports participants, employees in physically demanding occupations, or individuals looking to join certain clubs or organizations with specific health requirements. The purpose of this examination is to identify any underlying health conditions, injuries, or risk factors that could potentially impact an individual's ability to safely participate in the chosen activity.
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Preparticipation physical examination medical history is a form that includes information about a person's medical history, current health status, and any past injuries or illnesses.
Athletes who participate in organized sports or physical activities are typically required to file a preparticipation physical examination medical history.
Preparticipation physical examination medical history forms can be filled out by providing accurate and detailed information about past medical conditions, current medications, allergies, and family medical history.
The purpose of preparticipation physical examination medical history is to assess the individual's overall health, identify any potential risk factors, and ensure they are physically fit to participate in sports or physical activities.
Information such as past medical conditions, surgeries, medications, allergies, family history of medical conditions, and any current symptoms should be reported on the preparticipation physical examination medical history form.
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