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Sickle-cell disease / Sickle cell trait / Cell test / National Collegiate Athletic Association / Health / Medicine / Hematopathology


Athletic History/Physical Form Planned Sport(s) _______________________ (All spaces must be completed for this form to be considered for athletic eligibility.)
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Document Date: 2014-05-02 14:42:36

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Facility

University Requirement / University ID / /

MedicalCondition

university sickle cell trait / Allergies / ADHD / injury / No sickle cell anemia / cardiomyopathy / joint injury / sudden Cardiac Death / No dehydration / strain / No fatigue / No hypertension / shortness of breath / No seizures / sickle cell trait / illness/injury / tendonitis / prior Sickle Cell Trait / No head injury / Musculoskeletal Injuries / No diabetes / No asthma / heart disease / Marfan’s Syndrome / /

MedicalTreatment

surgery / physical therapy / /

Organization

Student Health Services and Athletic Department / Widener University Athletic Department / /

Person

Neck Shoulder / Neck Shoulder Upper / /

Position

pediatrician / athlete / Head / /

Product

ADHD/ADD Current Medication / /

SportsEvent

NCAA / the NCAA / /

Technology

diagnostic tests / MRI / /

SocialTag