LHSAA Medical History Evaluation Form
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Louisiana High School Athletic Association LHSAA, Web MEDICAL EXAMINATION A student shall annually pass a physical examination given by a licensed physician nurse practitioner that is in collaboration with a licensed physician or a licensed physician s assistant under the supervision of a licensed physician and complete an LHSAA Medical History Evaluation form prior to participating
LHSAA MEDICAL HISTORY EVALUATION IMPORTANT This Form
LHSAA MEDICAL HISTORY EVALUATION IMPORTANT This Form , Web Heart Murmur Chest Pain Tightness Asthma Prescribed Inhaler Menstrual irregularities Last Cycle Seizures Shortness of breath Coughing Rapid weight loss gain Kidney Disease Hernia Take supplements vitamins Irregular Heartbeat Knocked out Concussion Heat related problems Single Testicle Heart Disease Recent Mononucleosi High Bloo
Lhsaa Medical History Evaluation Printable Pdf Download
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LHSAA Web Student must pass a physical examination administered by a licensed physician a licensed nurse practitioner that is in collaboration with a licensed physician or a licensed physician s assistant under the supervision of a licensed physician and complete an LHSAA medical history evaluation form or the Louisiana School Entrance and General
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Web WAIVER FORM To the best of our knowledge we have given true amp accurate information amp hereby grant permission for the physical screening evaluation We understand the evaluation involves a limited examination and the screening is not intended to nor will it prevent injury or sudden death We further understand that if the LHSAA MEDICAL HISTORY EVALUATION Page 1 Of 2. Web You must annually pass a physical examination given by a licensed physician nurse practitioner that is in collaboration with a licensed physician or a licensed physician s assistant under the supervision of a licensed physician and complete an LHSAA Medical History Evaluation form prior to participating Web This form is to be used for the Louisiana High School Athletic Association LHSAA medical history evaluation It may also be used as a school entrance and or general health exam at the local school district s discretion If this form is being used for school entrance proper immunization documentation is also required See below
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