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Sports Participation Checkup

 

Child's name ____________________________________________________ 

I performed a complete physical exam on this patient on ________.

Medical problems: _______________________________________________ 

_________________________________________________________________ 

_________________________________________________________________ 

___ This child can participate in all sports and activities OR 

___ This child should have limited activity as follows:  

    _____________________________________________________________ 

    _____________________________________________________________ 

    _____________________________________________________________ 


Physician's name ________________________________________________

Physician's signature _________________________ Date ____________ 

Physician's phone number _______________________________ 
Published by McKesson Provider Technologies.
Last modified: 1997-04-01
Last reviewed: 2004-09-28
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
Copyright 2006 McKesson Corporation and/or one of its subsidiaries. All Rights Reserved.
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