| Document Date: 2014-10-17 15:25:31
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MedicalCondition chronic medical condition Any bone / Seizure Disorder Head Injury Chronic Bronchitis Asthma Emphysema Parkinson’s Disease Multiple Sclerosis Stroke / Seizure / Arthritis / High Blood Pressure / allergies / Morbid Obesity Spinal Muscular Atrophy Neuropathy Lymphedema Osteogenesis Imperfecta Cerebral Palsy Spina Bifida Epilepsy / NOT doing physical activity Diabetes Respiratory Disease / Prosthesis Yes No Spinal cord injury / / MedicalTreatment Amputation / / Position walker / Seizure Disorder Head / /
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Microsoft Word - Health History form