| Document Date: 2013-10-29 15:42:02
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Company BP / / Event Person Communication and Meetings / / IndustryTerm car accident / / MedicalCondition headan injury / allergies / Sprengel’s deformity / exercise-induced asthma / hypertension / heart infection / seizures / fainting / GENITALIA (MALES) HERNIA / stroke / acute infections / diabetes / unexplained heart attacks / seizure / pulmonary insufficiency / pain / nerve?cramps / injury / organic heart disease / sickle cell disease / extreme fatigue / severe muscle cramps / eating disorder / high blood pressure / sickle cell trait / heat stroke / sudden infant death syndrome / cough / unexplained seizure / anya chronic asthma / exercise asthma / chronic musculoskeletal condition / chronic medical illnesses / head injury / asthma / heat injury / / MedicalTreatment surgery / / Organization PA NP / NCHSAA Sports Medicine Advisory Committee / / Person Exam / / Position regular physician / ever told thebeen athlete / Personal Physician / athlete / Physician / Licensed Physician / Nurse / parent/legal custodian / Assistant / legal custodian / / Technology Sports Medicine / /
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NEW HANOVER COUNTY SCHOOLS PRE-PARTICIPATION SPORTS SCREENING (IN ACCORDANCE WITH NORTH CAROLINA HIGH SCHOOL ATHLETIC ASSOCIATION GUIDELINES) Student’s Name: Date of Birth: