| Document Date: 2014-05-15 12:06:42
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City Provider City / / Company CONTACT Limited / / IndustryTerm concussion management protocol / / MedicalCondition loss of consciousness / allergies / taken asthma / Hypertrophic cardiomyopathy / headaches / hypertension / OF ANAPHYLAXIS / cardiomyopathy / joint injury / Heart Infection / headache / severe viral infection / pressure sores / herpes infection / tendonitis / nausea / diabetes / seizure / High Cholesterol / pain / numbness / injury / sickle cell disease / severe muscle cramps / High Blood Pressure / sickle cell trait / infectious mononucleosis / dizziness / memory loss / myocarditis / significant heart arrhythmia / Marfan’s syndrome / head injury / asthma / Long QT Syndrome / / MedicalTreatment IMMUNIZATIONS / surgery / physical therapy / / Organization National Institute of Health / New Mexico Activities Association / / Person Neck Shoulder / Neck Shoulder Upper / / Position CLEARANCE FORM Athlete / Athlete / Physician / THE EXAMINING PHYSICIAN / Physical Examination Athlete / Student-Athlete / Head / / ProvinceOrState New Mexico / / Technology concussion management protocol / x-ray / MRI / / URL www.nmact.org / /
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The New Mexico Activities Association physical form provides schools, parents and providers with a recommended form. If the NMAA recommended Physical Form is to be used, please ensure that your child’s school grants pe