Get Form D -- Health Practitioner, Please Refer To The Letter & References ...

Filling out the FORM D for health practitioners is an essential step in ensuring accurate evaluation for student athletes participating in NIAA sanctioned sports. This guide provides step-by-step instructions to help you complete the form confidently and accurately online.

Follow the steps to complete the FORM D effectively.

1. Click ‘Get Form’ button to access the form and open it in an editor.
2. Begin filling out the physical examination section by entering the date of examination. Include the athlete's name, date of birth, height, weight, and optional % body fat.
3. In the vision section, record the right and left eye vision results as R 20/___ and L 20/___ respectively.
4. Move to the medical examination section and indicate normal or absent findings for pulse and blood pressure measurements. Document any abnormal findings in the space provided.
5. Complete the appearance assessment by marking observations related to eyes, ears, nose, throat, lymph nodes, lungs, abdomen, genitalia (if applicable), and skin.
6. Assess cardiovascular health by marking any murmurs and detailing findings related to radial and femoral pulses.
7. Evaluate musculoskeletal health by checking the athlete's neck, back, shoulders, arms, elbows, wrists, hands, hips, thighs, knees, legs, ankles, and feet. Note any stigmata of Marfan’s syndrome if present.
8. Decide whether the athlete is cleared or not cleared for participation, providing recommendations and reasons in the given sections.
9. Document the physician's name, address, license number, office phone number, and date. Ensure to include the signature of the health practitioner certifying the evaluation.
10. Review all entries for accuracy, then save changes, download, print, or share the completed form as necessary.

Complete the FORM D online for efficient and accurate processing.