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Participation Physical Evaluation HISTORY FORM(Note: This form is to be filled out by the patient and parent prior to seeing the physician. The physician should keep this form in the chart.) Date
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Fill in all required fields on the form.
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Once the form is filled out, take a stamp and place it on the designated area of the form.

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Forms that require a stamp are often needed for legal, administrative, or official purposes.
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The specific requirements for a stamped form may vary depending on the country, organization, or agency requesting the form.
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