Florida Atlantic University Physical Examination Demographics
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Physical Examination Demographics: Name:________________________________ SS# _____-___-_____ Sport________ Birth Date / Age ___________/____________
Height__________ Weight__________ Body Fat %__________ Pulse_____ BP___/___ General Medical Examination: HE _____________________________ ABD _______________________________ ENT _____________________________ GU _______________________________ Neck _____________________________ Hernia _______________________________ Chest _____________________________ Neuro. _______________________________ CV _____________________________ Skin _______________________________ Remarks: ________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________
Cervical / Thoracic Spine:___________________ Lumbar Spine:__________________________ ________________________________________ ______________________________________ ________________________________________ ______________________________________ ________________________________________ ______________________________________ ________________________________________ ______________________________________ Shoulder: ________________________________ Knee: _________________________________ ________________________________________ ______________________________________ ________________________________________ ______________________________________ ________________________________________ ______________________________________ ________________________________________ ______________________________________ Elbow: __________________________________ Hip: __________________________________ ________________________________________ ______________________________________ ________________________________________ ______________________________________ ________________________________________ ______________________________________ Wrist / Hand: _____________________________ Ankle / Foot: ___________________________ ________________________________________ ______________________________________ ________________________________________ ______________________________________ ________________________________________ ______________________________________ ________________________________________ ______________________________________ Comments: ______________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Circle One: The Athlete (may) (may not) participate in Florida Atlantic University athletics. __________________________________/_____ _____________________________/________ Internal Medicine Physician’s Signature / Date Orthopaedic Physician Signature / Date Directory: admin -> FAU admin -> Table Of Contents introduction 2 admin -> Town of Nags Head Annual Report admin -> Hurricanes are getting fiercer admin -> Ieee/iee electronic Library (iel) admin -> Project Title: Research and Development for goes-r risk Reduction Principal Investigator admin -> General information admin -> Annual Safety and Security Report FAU -> Florida Atlantic University Department of Athletics FAU -> Lightning Policy FAU -> Florida Atlantic University Drug Policy Download 7.92 Kb. Share with your friends:
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