Transcription of Ohio High School Athletic Association …
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Ohio High School Athletic Association …
X__Ohio high School Athletic Association Preparticipation Physical EvaluationDATE OF EXAM:_____Page 1 of 4 Name _____ Sex _____ Age _____ Date of Birth _____Grade_____ School _____ Sport(s) _____ Address _____ Phone _____Personal Physician_____ In case of emergency, contact: Name _____Relationship _____ Phone (H) _____(W)_____(Cell)_____(Cell)_____Histo ryThis section is to be carefully completed by the student and his/her parent(s) or legal guardian(s) before participation in interscholastic athletics in order to help detect possible "YES" answers in the space provided. Circle questions you don't know the answer you cough, wheeze, or have difficulty breathing during or after exercise? there anyone in your family who has asthma? a doctor ever denied or restricted you participation in sports for any reason?Yes you ever used an inhaler or taken asthma medicine? you born without or are you missing a kidney, an eye, a testicle, or any other organ?
Page 2 of 4 Physical Examination Form The section below is to be completed by physician or staff after history and consent forms are …
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