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    Preparticipation Physical Evaluation

    Uploaded by

    Paul Canaletti

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    © All Rights Reserved
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    Preparticipation Physical Evaluation

    Uploaded by

    Paul Canaletti
    18 views2 pages

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    © © All Rights Reserved

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    18 views2 pages

    Preparticipation Physical Evaluation

    Uploaded by

    Paul Canaletti

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
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    Physical Examination Date of Exam: 1/27/2022 Name: Eljah Canalet Sex male Age: 17 year old. Date of Bit: 6/14/2004 Temperature: 97.1F Pulse: 92 Respirations: 13 Blood Pressure: 118/64 Weight: 87-1 kg (192 Ib 0.3 02) (93 %, Z= 1.48, Source: CDC (Boys, 2-20 Years)) Height: 4.755 m (S' 8.08") (48 %, Z=-0.06, Source: CDC (Boys, 2-20 Years)) Vision: R 20/20 L 20120 Corrected: no’ Pupils: equal jearance Eves/EarsiNose/Tnreat [Lymph Nodes Heart Pulses [lungs bdomen enitalia (rales only) [Skin [Neurological iv) INeck leack houlderiarm [Elbowrforearm: isUhand Hip (thigh) iknee iLegvankie ‘00t (Functional: Duck-walk, single leg hop Clearance: Cleared for sports Full activity - No restrictions RYAN EARL ALANZALON MD, M.D. Electronic Phy: 28/2022 Date ‘Address: 400 CRAVEN RD ‘SAN MARCOS CA 92078-4201 Phone: Dept: 866-940-2218 Preparticipation Physical Evaluation “CLEARANCE FORM] Name Eli Canalt Sex male _| A® _17year cid | Dato of bith 6114/2008 W)_Cleared without resticton D1 Cleared, witn recommendations for further evaluation or treatment fr DD Not Clearedtor [) Allsports [) Certain sports: Recommendations: EMERGENCY INFORMATION No Known Alegies Other Information Name of physician (printtype) RYAN EARL ALANZALON MD, M.D. Date 12872022 ‘Address 400 CRAVEN RD. Phone Dept 866-940-2218 ‘SAN MARCOS Ca 92078-4201 Electronic Signature of physician _RYAN EARL ALANZALON MD. MD. Preparticipation Physical Evaluation (CLEARANCE FORM. Name Eliah Canalet Sex male Age 17yearold Date of bith 6742004 [¥) Cleared without restriction Zi eared, with recommendations fo further evaluation or treatment fr 1 Notcleared for [] Allsports [) Certain sports: Reason: Recommendations: EMERGENCY INFORMATION No Known Allergies (Other Information [Name of physician (printtype) RYAN EARL ALANZALON MO. M.D. Date 120/202 ‘Address 400 CRAVEN RD Phone Dept 856.940.2218 ‘SAN MARCOS CA 92078-4201 Electronic Signature of physician RYAN EARL ALANZALON MD, M.D,

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