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Campquestsc.org
PHYSICAL EXAM FORM CAMPER INFORMATION
Camper’s Name__________________________________________Date of Birth: ______________________
Parent/Legal Guardian: Please complete the Camper Information section above and provide this form and a copy of the camper’s completed Health History Form to your
child’s physician. Physician: Please review the camper’s Health History Form and complete remaining CURRENT HEALTH ASSESSMENT Date of Camper’s Most Recent Physical Exam: Today Other date (please specify): ______
Height: ___________Weight:___________ Blood Pressure: _____ /_______Blood Type:________(if known)
Is the camper undergoing treatment at this time for any medical conditions? NO YES (if
yes, please describe):________________________________________________________________________
______________________________________________________________________________________________
Will the camper be taking any prescribed medications while at camp? NO YES (if yes,
please describe name, dose, frequency, and reason for each medication):____________________
______________________________________________________________________________________________
Please list any allergies the camper has, including to medications, foods, environment
allergens, animal allergens, etc. Please also describe the camper’s reaction to each allergen. _____________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________ HEALTH HISTORY
Immunization history, including date of most recent tetanus shot: ____________________________
______________________________________________________________________________________________
Has the camper undergone any surgeries or hospitalizations? NO YES (please provides
dates/reasons):______________________________________________________________________________________________
RESTRICTIONS AND RECOMMENDATIONS Does the camper have any medical or health conditions that will require limitations or restrictions on his/her activity while at camp? NO YES If yes, please describe your recommendations:
______________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________
Place a check mark next to any of the over-the-counter medications below which should NOT be given to the child:
"I have reviewed the camper’s Health History Form and have discussed the camp program with the camper’s parent/legal guardian. It is my opinion that the camper is physically and
emotionally fit to participate in an active camp program, except as noted above."
Signature of Camper’s Physician:_____________________________Date:___________________________
Physician Name: ____________________________________________ Phone Number: (_____)__________
Address: _______________________________City:_____________________State:_________Zip:___________
Introduction 1978 USP XIX Fourth supplement : L1 designation for C18 column 1980 USP XX : 7 columns were classified -Classified HPLC column to 56 descriptions -More than 220 columns currently available in the worldwide market can be classified as L1 -How to select column for a particular application ? USP Approach -Use NIST Standard Reference Material (SRM) 870 to evaluate C18 column -SRM 8
Erectile Dysfunction and Constructs of Masculinity and Quality of Life in the Multinational Men’s Attitudes to Life Events and Sexuality (MALES) Study Michael S. Sand, PhD, MPH,* William Fisher, PhD,† Raymond Rosen, PhD,‡ Julia Heiman, PhD,§ andIan Eardley, MD¶*Bayer Schering Pharma AG, Wuppertal, Germany; †University of Western Ontario, London, Ontario, Canada;‡New England Researc