INSTRUCTIONS for Health Assessment complete sections A C Sports Physicals complete sections A B C. PART A NAME OF SPONSOR TELEPHONE HOME CELL SPONSOR UNIT / WORK ADDRESS TELEPHONE DUTY SPONSOR SSN SPOUSE S WORK PHONE CHILD HEALTH INFORMATION NAME OF CHILD BIRTH DATE DOES YOUR CHILD HAVE ON GOING MEDICAL CONCERNS YES SEX MALE FEMALE IF YES EXPLAIN CIRCUMSTANCES AND CURRENT STATUS NO IS YOUR CHILD ENROLLED IN EXCEPTIONAL FAMILY MEMBER PROGRAM YES MEDICAL HISTORY YES NO 1. CHILD AND YOUTH SERVICES HEALTH ASSESSMENT / SPORTS PHYSICAL DATA REQUIRED BY THE PRIVACY ACT OF 1994 PRINCIPAL PURPOSE Information is used by DA personnel to 1 verify child health status of immunization per admission requirements 2 note special program considerations or restriction on child participation 3 execute emergency medical procedure for chronic illnesses/conditions 4 refer child for enrollment in Exceptional Family Member Program 5 certify physically fit to participate in sports. ROUTINE USES No information is....
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How to fill out the Da Form 7725 online
Filling out the Da Form 7725 online is a straightforward process designed to ensure that child health assessments and sports physicals are completed efficiently. This guide will provide you with clear, step-by-step instructions to navigate the form successfully.
Follow the steps to complete the Da Form 7725 accurately
- Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
- Complete Part A by entering the sponsor's name, contact information, and details about the child, including their health information and enrollment status in the Exceptional Family Member Program.
- In Part A, provide the child's medical history by answering the questions about past hospitalizations, allergies, and any existing medical conditions. Ensure to elaborate on any 'yes' answers.
- List any ongoing medications, including names, dosages, and types of allergies in the appropriate sections.
- Proceed to Part B, where a licensed health care professional will assess the child's physical condition. This section requires measurements such as age, height, weight, and blood pressure, along with an evaluation of various health aspects.
- Based on the assessment, indicate any restrictions or recommendations regarding sports participation. Ensure that all comments and evaluations are clearly noted.
- Complete Part C by describing any special medical considerations that may affect the child's participation in activities. Confirm if the child can participate in normal Child and Youth Services programs.
- Ensure that a licensed health care professional signs and dates the form. As a parent or guardian, also add your signature and the date of approval.
- Finally, review all entries for accuracy before saving changes. You can then download, print, or share the completed form as needed.
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