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April 01, 2015 Physician’s and Parents’ Certificate for Jr. High & High School Athletics University Interscholastic League and Flour Bluff Independent School District Attention: This form must be signed by both the
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Document Date: 2015-06-08 08:25:14

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Company

BP / /

Facility

University Interscholastic League / /

IndustryTerm

corrective equipment / protective equipment / food / /

MedicalCondition

medical illness / blisters / severe headaches / Marfan's syndrome / allergies / hypertrophic cardiomyopathy / Brugada syndrome / cardiomyopathy / acne / chest pain / warts / severe viral infection / such illness / strain / enlarged heart / sickness / pectus excavatum / itching / seizure / seasonal allergies / numbness / high cholesterol / pain / injury / high blood pressure / sickle cell trait / mononucleosis / cell disease / illness / myocarditis / head injury / asthma / long QT syndrome / /

MedicalTreatment

Chiropractic / surgery / /

Organization

High & High School Athletics University Interscholastic League / Board of Nurse Examiners / State Board of Physician Assistant Examiners / University Interscholastic League / /

Position

hospital representative / physician / physician assistant / Birth Address Grade Phone School Personal Physician / Physician / a Physician Assistant / Registered Nurse / athlete / nurse / Physician / representative / chiropractor / or nurse practitioner / Advanced Practice Nurse / physician assistant / chiropractor / Head / /

Technology

cellular telephone / /

SocialTag