Transcription of Pre-Participation Physical Evaluation PPE
{{id}} {{{paragraph}}}
Example: barber
Pre-Participation Physical Evaluation PPE
Pre-Participation Physical EvaluationKansas State High School Activities Association 601 SW Commerce Place PO Box 495 Topeka, KS 66601 785-273-5329 HISTORY FORM (should be filled out by the student and parent/guardian prior to the Physical examination)PPEName Sex Age Date of birthGrade School Sport(s)Home Address Phone -Personal physician Parent Email General Questions Yes No 1. Have you had a medical condition or injury since your last check up or sports Physical ? 2. Has a doctor ever denied or restricted your participation in sports for any reason? 3. Do you have any ongoing medical conditions? If so, please identify below: Asthma Anemia Diabetes Infections Other: _____ 4. Have you ever spent the night in the hospital?
Pre-Participation Physical Evaluation Kansas State High School Activities Association • 601 SW Commerce Place • PO Box 495 • Topeka, KS 66601 • 785-273-5329
Tags:
Information
Domain:
Source:
Link to this page:
Please notify us if you found a problem with this document: