Preparticipation Physical Examination - - Medical History Form 2025

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  1. Click ‘Get Form’ to open the Preparticipation Physical Examination - - Medical History Form in the editor.
  2. Begin by entering your name, gender, date of birth, and date of exam at the top of the form. This information is essential for identification.
  3. Fill in your age, grade, and intended sport(s) to provide context for your medical history.
  4. List all medications you are currently taking, including prescriptions and over-the-counter drugs. Be thorough to ensure accurate health assessments.
  5. Indicate any allergies you have by checking the appropriate boxes and specifying if necessary.
  6. Answer the general questions regarding your medical history honestly. Circle any questions you are unsure about for further discussion with a healthcare provider.
  7. Complete the heart health questions about yourself and your family, ensuring to check all relevant boxes.
  8. Address any bone and joint questions as well as female-specific inquiries if applicable.
  9. Finally, review all your answers for accuracy before signing at the bottom of the form. Ensure both athlete and parent/guardian signatures are included.

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Pre-Participation Physical Examination (PPE) Form. This form is used by a physician to examine children before they are allowed to participate in sports.
This form is used by a physician to examine children before they are allowed to participate in sports.
Primary cares name and contact information. Medical history, including allergies and immunizations. For patients with a history of a heart ailment or cardiac event, a statement from your primary care provider or treating physician.
The primary purpose of a preparticipation physical examination is to identify risk factors that may predispose an athlete to physical and/or psychological injury.
The general goals of a PPE are determining the general physical and psychological health of the athlete; evaluating for life-threatening or disabling conditions, including risk of sudden cardiac arrest and other conditions that may predispose the athlete to illness or injury; and serving as an entry point into the
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Components of an appropriate PPE General Health Screen. Vital signs, height, weight, blood pressure, vision testing, pulmonary, neurological, abdominal, skin and genitalia exam. Cardiovascular Screen. Hear murmurs, femoral pulses, Marfan syndrome characteristics, blood pressure. Neurologic Screen. General Medical Screen.
The PPE comprises several parts: past medical history, sport-specific history, family history and physical exam. A well-rounded physical activity program includes aerobic exercise and strength training exercise, but not necessarily in the same session.

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