€¦ · 01/05/2020 · SDHSAA Name: Date of Exam: HEALTH HISTORY FORM - To be completed (with parent/guardian if student is under 18) in years when a physical exam is giveri, prior

Page 1 <img data-url='document/01052020-sdhsaa-name-date-of-exam-health-history-form-to-be-completed-with.html?page=1' data-page='1' class='cut-thumb lazyload' alt='Page 1: €¦ · 01/05/2020 · SDHSAA Name: Date of Exam: HEALTH HISTORY FORM - To be completed (with parent/guardian if student is under 18) in years when a physical exam is giveri, prior' loading='lazy' src='data:image/gif;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mNk+P+/HgAFhAJ/wlseKgAAAABJRU5ErkJggg==' data-src='https://reader034.cupdf.com/reader034/viewer/2022050220/5f658a194727a92a6354c1d2/html5/thumbnails/1.jpg' width='140' height='200' /> Page 2 <img data-url='document/01052020-sdhsaa-name-date-of-exam-health-history-form-to-be-completed-with.html?page=2' data-page='2' class='cut-thumb lazyload' alt='Page 2: €¦ · 01/05/2020 · SDHSAA Name: Date of Exam: HEALTH HISTORY FORM - To be completed (with parent/guardian if student is under 18) in years when a physical exam is giveri, prior' loading='lazy' src='data:image/gif;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mNk+P+/HgAFhAJ/wlseKgAAAABJRU5ErkJggg==' data-src='https://reader034.cupdf.com/reader034/viewer/2022050220/5f658a194727a92a6354c1d2/html5/thumbnails/2.jpg' width='140' height='200' /> Page 3 <img data-url='document/01052020-sdhsaa-name-date-of-exam-health-history-form-to-be-completed-with.html?page=3' data-page='3' class='cut-thumb lazyload' alt='Page 3: €¦ · 01/05/2020 · SDHSAA Name: Date of Exam: HEALTH HISTORY FORM - To be completed (with parent/guardian if student is under 18) in years when a physical exam is giveri, prior' loading='lazy' src='data:image/gif;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mNk+P+/HgAFhAJ/wlseKgAAAABJRU5ErkJggg==' data-src='https://reader034.cupdf.com/reader034/viewer/2022050220/5f658a194727a92a6354c1d2/html5/thumbnails/3.jpg' width='140' height='200' /> Page 4 <img data-url='document/01052020-sdhsaa-name-date-of-exam-health-history-form-to-be-completed-with.html?page=4' data-page='4' class='cut-thumb lazyload' alt='Page 4: €¦ · 01/05/2020 · SDHSAA Name: Date of Exam: HEALTH HISTORY FORM - To be completed (with parent/guardian if student is under 18) in years when a physical exam is giveri, prior' loading='lazy' src='data:image/gif;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mNk+P+/HgAFhAJ/wlseKgAAAABJRU5ErkJggg==' data-src='https://reader034.cupdf.com/reader034/viewer/2022050220/5f658a194727a92a6354c1d2/html5/thumbnails/4.jpg' width='140' height='200' /> Page 5 <img data-url='document/01052020-sdhsaa-name-date-of-exam-health-history-form-to-be-completed-with.html?page=5' data-page='5' class='cut-thumb lazyload' alt='Page 5: €¦ · 01/05/2020 · SDHSAA Name: Date of Exam: HEALTH HISTORY FORM - To be completed (with parent/guardian if student is under 18) in years when a physical exam is giveri, prior' loading='lazy' src='data:image/gif;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mNk+P+/HgAFhAJ/wlseKgAAAABJRU5ErkJggg==' data-src='https://reader034.cupdf.com/reader034/viewer/2022050220/5f658a194727a92a6354c1d2/html5/thumbnails/5.jpg' width='140' height='200' /> Page 6 <img data-url='document/01052020-sdhsaa-name-date-of-exam-health-history-form-to-be-completed-with.html?page=6' data-page='6' class='cut-thumb lazyload' alt='Page 6: €¦ · 01/05/2020 · SDHSAA Name: Date of Exam: HEALTH HISTORY FORM - To be completed (with parent/guardian if student is under 18) in years when a physical exam is giveri, prior' loading='lazy' src='data:image/gif;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mNk+P+/HgAFhAJ/wlseKgAAAABJRU5ErkJggg==' data-src='https://reader034.cupdf.com/reader034/viewer/2022050220/5f658a194727a92a6354c1d2/html5/thumbnails/6.jpg' width='140' height='200' /> Page 7 <img data-url='document/01052020-sdhsaa-name-date-of-exam-health-history-form-to-be-completed-with.html?page=7' data-page='7' class='cut-thumb lazyload' alt='Page 7: €¦ · 01/05/2020 · SDHSAA Name: Date of Exam: HEALTH HISTORY FORM - To be completed (with parent/guardian if student is under 18) in years when a physical exam is giveri, prior' loading='lazy' src='data:image/gif;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mNk+P+/HgAFhAJ/wlseKgAAAABJRU5ErkJggg==' data-src='https://reader034.cupdf.com/reader034/viewer/2022050220/5f658a194727a92a6354c1d2/html5/thumbnails/7.jpg' width='140' height='200' /> Page 8 <img data-url='document/01052020-sdhsaa-name-date-of-exam-health-history-form-to-be-completed-with.html?page=8' data-page='8' class='cut-thumb lazyload' alt='Page 8: €¦ · 01/05/2020 · SDHSAA Name: Date of Exam: HEALTH HISTORY FORM - To be completed (with parent/guardian if student is under 18) in years when a physical exam is giveri, prior' loading='lazy' src='data:image/gif;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mNk+P+/HgAFhAJ/wlseKgAAAABJRU5ErkJggg==' data-src='https://reader034.cupdf.com/reader034/viewer/2022050220/5f658a194727a92a6354c1d2/html5/thumbnails/8.jpg' width='140' height='200' /> Page 9 <img data-url='document/01052020-sdhsaa-name-date-of-exam-health-history-form-to-be-completed-with.html?page=9' data-page='9' class='cut-thumb lazyload' alt='Page 9: €¦ · 01/05/2020 · SDHSAA Name: Date of Exam: HEALTH HISTORY FORM - To be completed (with parent/guardian if student is under 18) in years when a physical exam is giveri, prior' loading='lazy' src='data:image/gif;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mNk+P+/HgAFhAJ/wlseKgAAAABJRU5ErkJggg==' data-src='https://reader034.cupdf.com/reader034/viewer/2022050220/5f658a194727a92a6354c1d2/html5/thumbnails/9.jpg' width='140' height='200' /> Page 10 <img data-url='document/01052020-sdhsaa-name-date-of-exam-health-history-form-to-be-completed-with.html?page=10' data-page='10' class='cut-thumb lazyload' alt='Page 10: €¦ · 01/05/2020 · SDHSAA Name: Date of Exam: HEALTH HISTORY FORM - To be completed (with parent/guardian if student is under 18) in years when a physical exam is giveri, prior' loading='lazy' src='data:image/gif;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mNk+P+/HgAFhAJ/wlseKgAAAABJRU5ErkJggg==' data-src='https://reader034.cupdf.com/reader034/viewer/2022050220/5f658a194727a92a6354c1d2/html5/thumbnails/10.jpg' width='140' height='200' /> Page 11 <img data-url='document/01052020-sdhsaa-name-date-of-exam-health-history-form-to-be-completed-with.html?page=11' data-page='11' class='cut-thumb lazyload' alt='Page 11: €¦ · 01/05/2020 · SDHSAA Name: Date of Exam: HEALTH HISTORY FORM - To be completed (with parent/guardian if student is under 18) in years when a physical exam is giveri, prior' loading='lazy' src='data:image/gif;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mNk+P+/HgAFhAJ/wlseKgAAAABJRU5ErkJggg==' data-src='https://reader034.cupdf.com/reader034/viewer/2022050220/5f658a194727a92a6354c1d2/html5/thumbnails/11.jpg' width='140' height='200' /> Page 12 <img data-url='document/01052020-sdhsaa-name-date-of-exam-health-history-form-to-be-completed-with.html?page=12' data-page='12' class='cut-thumb lazyload' alt='Page 12: €¦ · 01/05/2020 · SDHSAA Name: Date of Exam: HEALTH HISTORY FORM - To be completed (with parent/guardian if student is under 18) in years when a physical exam is giveri, prior' loading='lazy' src='data:image/gif;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mNk+P+/HgAFhAJ/wlseKgAAAABJRU5ErkJggg==' data-src='https://reader034.cupdf.com/reader034/viewer/2022050220/5f658a194727a92a6354c1d2/html5/thumbnails/12.jpg' width='140' height='200' /> Page 13 <img data-url='document/01052020-sdhsaa-name-date-of-exam-health-history-form-to-be-completed-with.html?page=13' data-page='13' class='cut-thumb lazyload' alt='Page 13: €¦ · 01/05/2020 · SDHSAA Name: Date of Exam: HEALTH HISTORY FORM - To be completed (with parent/guardian if student is under 18) in years when a physical exam is giveri, prior' loading='lazy' src='data:image/gif;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mNk+P+/HgAFhAJ/wlseKgAAAABJRU5ErkJggg==' data-src='https://reader034.cupdf.com/reader034/viewer/2022050220/5f658a194727a92a6354c1d2/html5/thumbnails/13.jpg' width='140' height='200' /> Page 14 <img data-url='document/01052020-sdhsaa-name-date-of-exam-health-history-form-to-be-completed-with.html?page=14' data-page='14' class='cut-thumb lazyload' alt='Page 14: €¦ · 01/05/2020 · SDHSAA Name: Date of Exam: HEALTH HISTORY FORM - To be completed (with parent/guardian if student is under 18) in years when a physical exam is giveri, prior' loading='lazy' src='data:image/gif;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mNk+P+/HgAFhAJ/wlseKgAAAABJRU5ErkJggg==' data-src='https://reader034.cupdf.com/reader034/viewer/2022050220/5f658a194727a92a6354c1d2/html5/thumbnails/14.jpg' width='140' height='200' /> Page 15 <img data-url='document/01052020-sdhsaa-name-date-of-exam-health-history-form-to-be-completed-with.html?page=15' data-page='15' class='cut-thumb lazyload' alt='Page 15: €¦ · 01/05/2020 · SDHSAA Name: Date of Exam: HEALTH HISTORY FORM - To be completed (with parent/guardian if student is under 18) in years when a physical exam is giveri, prior' loading='lazy' src='data:image/gif;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mNk+P+/HgAFhAJ/wlseKgAAAABJRU5ErkJggg==' data-src='https://reader034.cupdf.com/reader034/viewer/2022050220/5f658a194727a92a6354c1d2/html5/thumbnails/15.jpg' width='140' height='200' />

€¦ · 01/05/2020 · SDHSAA Name: Date of Exam: HEALTH HISTORY FORM - To be completed (with parent/guardian if student is under 18) in years when a physical exam is giveri, prior

Documents