Transcription of HISTORY FORM - .NET Framework
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HISTORY FORM - .NET Framework
PREPARTICIPATION physical EVALUATION | Ohio high School Athletic Association 2021-2022 HISTORY FORM Note: Complete and sign this form (with your parents if younger than 18) before your appointment. Name:_____ Date of birth: _____ Grade in School: _____ Date of examination: Sex assigned at birth (F, M, or intersex): Sport(s): How do you identify your gender? (F, M, or other): Patient Health Questionnaire Version 4 (PHQ-4) Over the last 2 weeks, how often have you been bothered by any of the following problems? (Circle response.)
PREPARTICIPATION PHYSICAL EVALUATION – Ohio High School Athletic Association – 2021-2022 PHYSICAL EXAMINATION FORM Name: Date of Birth: Grade in School: PHYSICIAN REMINDERS 1. Consider additional questions on more-sensitive issues.
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