Medical Eligibility Form
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Medically Eligible For All Sports Without Restriction Medically Eligible For All Sports Without Restriction With Recommendations For Further Evaluation Or Treatment Of Medically Eligible For Certain Sports Not Medically Eligible Pending Further Evaluation
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You Must Also Sign The Application In Two Places To:
_________________________ medically eligible for all sports without restriction medically eligible for all sports without restriction with recommendations for further evaluation or. The information will be used to determine the patient’s eligibility to receive assistance through the uninsured care programs. Issued to student/parent(s)/guardian, completed by student/parent(s)/guardian, taken to healthcare professional (md/do/arnp/pa/dc), retained by healthcare professional. The completed and signed ppe history form must then be presented to the examining licensed medical professional (lmp)
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