department of athletics policies & procedures - UNC Wilmington ...

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Appendix VI
Sickle – Cell Trait Testing Form
The University of North Carolina Wilmington
Department of Athletic Training
Sickle – Cell Trait Testing Form
Name:
Last First MI
Sport(s) Year of Eligibility: FR SO JR SR 5th Yr
Date of Test: ______________
** Please attach the physician’s note to this form indicating the results of the test **
Sickle Cell Positive: Yes No
Physician Notes:
Sickle Cell Trait: Yes No
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