El cuidado o la crianza del hijo menor de un pariente - Bet Tzedek

P r e-P arttcip aFon Phv sical Exam ( t o b e e o mo I e t e d bv p h v s ic i an ITrinitv School at Meadow View,2849 Meadow View Rd., Falls Church, VA 22042Physical ExaminationDate:Name: MIF Age _ Date of BirthHeight Weight BP PulseVision Pt20l L2Al Corrected YA.l Pupils Audiogramc.)ogOa)-lCardiopulmonaryPulsesHeartLungsTanner Stage I 2SkinAbdominalGenitalialhemiaMusculoskeletalNeck/SpineShoulderArm/EibowWrist/HandLvmohaticBackKneelllipAnklelFeetEyes" Ears. NoseOtherNormal Abnormal Findinss InitialsaJ 4 5Clearance:tr Cleared to participate without restriction:Soccer Lacrosse Basketball Volleyball Cross CountryI Cleared after completing evaluation/rehabilitation for:Track- - - -n Not cleared for:Collision Contact Non-contact Strenuous _ Moderately strenuous _ Non-strenuousDue to:Recommendation:Name of physicianAddress:PhoneDoctorts signature: