immunizations / emergency treatment / surgical treatment / surgery / major surgery / /
Organization
American Academy of Family Physicians / Sports Medicine / and American Osteopathic Academy of Sports Medicine / Thomasville City School System Athletic Department / Thomasville City School / Georgia High School Association / National Federation of State High School / American Orthopaedic Society for Sports Medicine / Thomasville City Schools Department / American College of Sports Medicine / Thomasville City School System’s Athletic Department / American Osteopathic Academy of Sports Medicine / American Medical Society for Sports Medicine / American Academy of Pediatrics / STUDENT/PARENT CONCUSSION AWARENESS FORM SCHOOL / Thomasville City Board of Education / Athletic Director’s Office / Thomasville City School's Athletic Department / /
Person
GUARDIAN FORM / /
Position
Family Physician / above named athlete / physician / Any athlete / Player / licensed physician / Signature Date Coach / Date athlete / Director / No athlete / administrator / athlete / nurse / coach / BASEBALL CROSS COUNTRY SOFTBALL SOCCER BASKETBALL FOOTBALL SWIMMING TRACK CHEERLEADING GOLF TENNIS ATHLETE / physician assistant / Signature Date Student-Athlete / attending physician / /
■■ Preparticipation Physical Evaluation HISTORY FORM (Note: This form is to be filled out by the patient and parent prior to seeing the physician. The physician should keep this form in the chart.) Date of Exam