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Get TX UIL Preparticipation Physical Evaluation - Medical History 2017

Letic activities. These questions are designed to determine if the student has developed any condition which would make it hazardous to participate in an athletic event. Student's Name: (print) Sex Age Date of Birth Address Grade Phone School Personal Physician Phone In case of emergency, contact: Name Relationship Phone (H) (W) Explain Yes answers in the box below**. Circle questions you don t know the answers to. 1. Have you had a medical illness or injury since your last c.

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