Annual Health and Medical Record
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 THREE PART FORM will help ensure you meet the minimum standards for participation in various activities. Note that unit leaders must always protect the privacy of unit participants by protecting their medical information.
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 is the physical exam that is required for all campers and adult leaders staying overnight at Yawgoog. Part C is to be completed and signed by a certified and licensed health-care provider—physician (MD or DO), nurse practitioner, or physician assistant.
Part D is required to be reviewed by all participants of a high-adventure program at one of the national high-adventure bases and shared with the examining health-care provider before completing Part C. This is not needed at Yawgoog.
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)
- Lack of appropriate immunizations
- 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.
Yawgoog Health Form Policy for 2014
Scouts and Leaders attending Camp Yawgoog during the summer of 2014 must use the new BSA Medical form. The new Medical form is mandatory for all persons staying overnight at Yawgoog Scout Reservation. If you have any questions, please email the Reservation Director.
All scouts (and adults who attend events) need to have a health form on file. The form is also now a requirement for attending Yawgoog. It does requires a doctor's signature, so by telling you about it now, so you have two months to get it in! If you have already had your physical, you can always mail or drop off a copy at the doctor's office so he can sign it without an appointment.
For a copy of the 2014 BSA Health form CLICK HERE. If you check the box on the top right labeled "Highlight fields", you can type the info into the form and save it on your computer. This makes it more readable and come next year if they don't change the form, you can reuse all the info that you typed in.
Common mistakes include:
- Missing emergency contact information (Part A)
- Incomplete medication information (Part A)
- Missing medical insurance card (Part A)
- Missing parent/guardian signature (Part A& B)
- Missing physician signature (Part A & C)
Submitting your medical form
Scouts attending camp with their troop should submit their medical forms to the unit leader. \
Scouts attending camp in the provisional troop should bring their form with them to check-in on Sunday. If you have attended camp with your troop earlier in the summerwe can transfer your medical form.
MEDICAL FORMS ARE NOT RETURNED AT THE END OF CAMP. Always submit a COPY of your medical form. Keep the original for use at other Scouting activities.
Information about the Health Insurance Portability and Accountability Act (HIPAA) may be found athttp://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
All BSA Health forms can be found at the following link: