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Get TX UIL Preparticipation Physical Evaluation - Medical History 2020-2024

Ties. These questions are designed to determine if the student has developed any condition which would make it hazardous to participate in an 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 check up or physical?.

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