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Medical education in the United States / Osteopathic medicine / Sports medicine / Osteopathic medicine in the United States / American Orthopaedic Society for Sports Medicine / Physician / Ohio High School Athletic Association / Family medicine / Orthopaedic sports medicine / Medicine / Osteopathy / Orthopedic surgery


Ohio High School Athletic Association PREPARTICIPATION PHYSICAL EVALUATIONPage 1 of 6 HISTORY FORM – Please be advised that this paper form is no longer the OHSAA standard. (Note: This form is to be filled o
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Document Date: 2015-05-06 11:23:10

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Facility

American College of Sports Medicine / /

IndustryTerm

transportation / energy drinks / nutritional-including energy drinks/ protein supplements / assistive device / family insurance / family insurance company name / unexplained car accident / interscholastic sports programs / /

MedicalCondition

myopia / Allergies / tinea corporis Neurologic MUSCULOSKELETAL Neck Back Shoulder/arm Elbow/forearm Wrist/hand/fingers Hip/thigh Knee Leg/ankle Foot/toes Functional Duck walk / hypertrophic cardiomyopathy / headaches / catecholaminergic polymorphic ventricular tachycardia / HIV / MRSA (staph) skin infection / heart infection / arachnodactyly / unexplained fainting / cold sores / herpes / frequent seizures / pectus excavatum / juvenile arthritis / short QT syndrome / numbness / injury / specific allergy / eye injury / muscle cramps / sudden infant death syndrome / illness / autonomic dysreflexia / hearing loss / unexplained seizure / muscle spasticity / bladder Numbness / head injury / asthma / long QT syndrome / taken asthma / Brugada syndrome / unexplained seizures / joint injury / disease / pressure sores / Easy bleeding Enlarged spleen Hepatitis Osteopenia / hypothermia / seizure disorder / dwarfism / hernia / Hepatitis B. Although serious injuries / High cholesterol / pain / Marfan syndrome / eating disorder / epilepsy / sickle cell trait / High blood pressure / infectious mononucleosis / arryhthmogenic right ventricular cardiomyopathy / infectious disease / connective tissue disease / syndrome / injuries / /

MedicalTreatment

surgery / /

Organization

American Academy of Family Physicians / Sports Medicine / and American Osteopathic Academy of Sports Medicine / Ohio High School Athletic Association / American Orthopaedic Society for Sports Medicine / American College of Sports Medicine / American Academy of Pediatrics / Department of Health / OHSAA / /

Person

Code / /

Position

personal representative / principal and athletic administrator / A.N.P. EMERGENCY INFORMATION Personal Physician / PHYSICIAN / student-athlete / athletic director / coach / physical education teacher / school nurse / personal physician / school administrator / ATHLETE / assistant / /

Technology

x-ray / Sports Medicine / MRI / /

URL

ohsaa.org / /

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