Physical History Form

Physical History Form - This form is to be filled out by the patient and parent prior to seeing the physician. This form should be completed by the student’s physician at the time of a physical. It should not be shared with schools. Preparticipation physical evaluation history form (note: This form should be maintained by the healthcare provider completing the physical exam (medical home). A copy of the physical exam is on record in my office and can be made available to the school at the request of the parents. Consider gu exam if in private setting. Consider ecg, echocardiogram, and referral to cardiology for abnormal cardiac history or exam. The physical exam must be completed by a healthcare provider who is a licensed physician, advanced practice nurse or physician assistant.

This form is to be filled out by the patient and parent prior to seeing the physician. It should not be shared with schools. Preparticipation physical evaluation history form (note: Consider ecg, echocardiogram, and referral to cardiology for abnormal cardiac history or exam. Consider gu exam if in private setting. This form should be maintained by the healthcare provider completing the physical exam (medical home). The physical exam must be completed by a healthcare provider who is a licensed physician, advanced practice nurse or physician assistant. This form should be completed by the student’s physician at the time of a physical. A copy of the physical exam is on record in my office and can be made available to the school at the request of the parents.

Preparticipation physical evaluation history form (note: A copy of the physical exam is on record in my office and can be made available to the school at the request of the parents. Consider gu exam if in private setting. This form should be maintained by the healthcare provider completing the physical exam (medical home). This form is to be filled out by the patient and parent prior to seeing the physician. Consider ecg, echocardiogram, and referral to cardiology for abnormal cardiac history or exam. It should not be shared with schools. The physical exam must be completed by a healthcare provider who is a licensed physician, advanced practice nurse or physician assistant. This form should be completed by the student’s physician at the time of a physical.

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It Should Not Be Shared With Schools.

Consider ecg, echocardiogram, and referral to cardiology for abnormal cardiac history or exam. Preparticipation physical evaluation history form (note: This form should be maintained by the healthcare provider completing the physical exam (medical home). This form should be completed by the student’s physician at the time of a physical.

Consider Gu Exam If In Private Setting.

The physical exam must be completed by a healthcare provider who is a licensed physician, advanced practice nurse or physician assistant. A copy of the physical exam is on record in my office and can be made available to the school at the request of the parents. This form is to be filled out by the patient and parent prior to seeing the physician.

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