More examples in Healthcare/Medical Examination Reports
Sports Activity Medical Examination Example
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Text in this example:
SPORTS ACTIVITY NAME OF DECEDENT: This form is to be completed in addition to the ROD form in these guidelines TYPE OF SPORT DECEDENT WAS INVOLVED IN: WAS THIS SPORT PLAYED INDOORS OR OUTDOORS? DESCRIBE THE PLAYING SURFACE: WAS THE ACCIDENT OR INJURY CAUSED BY AN INSTRUMENT OR PIECE OF EQUIPMENT USED BY
THE DECEDENT OR ANOTHER PLAYER (EXPLAIN)? IF SAFETY EQUIPMENT IS REQUIRED FOR THIS SPORT, DESCRIBE IN DETAIL, AND INDICATE IF
DECEDENT WAS DRESS ED APPROPRIATELY AT TIME OF PLAY: DID THE ACCIDENT OR INJURY INVOLVE A PUSH OR MOTORIZED VEHICLE OF ANY SORT
(EXPLAIN AND DESCRIBE IN DETAIL)? WERE ANY LIQUIDS OR SALT TABLETS OR MEDICATIONS BEING USED BY DECEDENT AT TIME OF
PLAY OR SHORTLY BEFORE (DESCRIBE): WHAT WAS THE DECEDENT'S LEVEL OF EXPERTISE IN THIS SPORT? NOVICE INTERMEDIATE MASTER OTHER: HAS THE DECEDENT EVER BEEN INJURED IN THIS OR ANY OTHER SPORT (EXPLAIN)? NAME OF INVESTIGATOR DMI#
THE DECEDENT OR ANOTHER PLAYER (EXPLAIN)? IF SAFETY EQUIPMENT IS REQUIRED FOR THIS SPORT, DESCRIBE IN DETAIL, AND INDICATE IF
DECEDENT WAS DRESS ED APPROPRIATELY AT TIME OF PLAY: DID THE ACCIDENT OR INJURY INVOLVE A PUSH OR MOTORIZED VEHICLE OF ANY SORT
(EXPLAIN AND DESCRIBE IN DETAIL)? WERE ANY LIQUIDS OR SALT TABLETS OR MEDICATIONS BEING USED BY DECEDENT AT TIME OF
PLAY OR SHORTLY BEFORE (DESCRIBE): WHAT WAS THE DECEDENT'S LEVEL OF EXPERTISE IN THIS SPORT? NOVICE INTERMEDIATE MASTER OTHER: HAS THE DECEDENT EVER BEEN INJURED IN THIS OR ANY OTHER SPORT (EXPLAIN)? NAME OF INVESTIGATOR DMI#