(Valid for 12 calendar months)
Policy on Use of the Annual Health and Medical Record
In order to provide better care for its members and to assist them in better understanding their own physical capabilities, the Boy Scouts of America recommends that everyone who participates in a Scouting event have an annual medical evaluation by a certified and licensed health-care provider—a physician (MD or DO), nurse practitioner, or physician assistant. Providing your medical information on this four-part form
Note: This record is provided as a fillable PDF, and members are encouraged to fill it out on their computer, then print the record (rather than printing the record and filling it out by hand). Doing this will improve the readability and accuracy of each member's medical information. For additional information about safeguarding your medical information, click here.
Parts A and B
are to be completed at least annually by participants in all Scouting events. This health history, parental/guardian informed consent and release agreement, and talent release statement are to be completed by the participant and parents/guardians.
Part C
Part D
- Philmont Scout Ranch
. Participants and guests for Philmont activities that are conducted with limited access to the backcountry, including most Philmont Training Center conferences and family programs, will not require completion of Part C. However, participants should review Part D to understand potential risks inherent at 6,700 feet in elevation in a dry Southwest environment. Please review specific registration information for the activity or event.
- Northern Tier National High Adventure Program
.
- Florida National High Adventure Sea Base
. The PADI medical form
is also required if scuba diving at this base.
- Summit Bechtel Reserve
Based on the vast experience of the medical community, the BSA has identified the following risk factors that may limit your participation in various outdoor adventures.
- Excessive body weight
- Heart disease
- Hypertension (high blood pressure)
- Diabetes
- Seizures
- Lack of appropriate immunizations
- Asthma
- Allergies/anaphylaxis
- Muscular/skeletal injuries
- Psychiatric/psychological and emotional difficulties
The taking of prescription medication is the responsibility of the individual taking the medication and/or that individual’s parent or guardian. A leader, after obtaining all the necessary information, can agree to accept the responsibility of making sure a youth takes the necessary medication at the appropriate time, but the BSA does not mandate or necessarily encourage the leader to do so. Also, if state laws are more limiting, they must be followed.
Frequently Asked Questions (FAQs)
Information about the Health Insurance Portability and Accountability Act (HIPAA) may be found at http://www.hhs.gov/ocr/privacy/
- Philmont Scout Ranch: www.philmontscoutranch.org
or 575-376-2281
- Northern Tier National High Adventure Program: www.ntier.org
or 218-365-4811
- Florida National High Adventure Sea Base: www.bsaseabase.org
or 305-664-5612
- Summit Bechtel Reserve: http://summit.scouting.org/
or 304-250-6750
- National Scout jamboree: www.bsajamboree.org

