Nscadm 001 - Cadet Application Report Of Medical Exam
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1
2CADET APPLICATION
FOR OFFICIAL USE ONLY
U.S. NAVAL SEA CADET CORPS
U.S. NAVY LEAGUE CADET CORPS
REPORT OF MEDICAL EXAM
INSTRUCTIONS
Acceptance criteria for the Naval Sea Cadet Corps/Navy League Cadet Corps (NSCC/NLCC) are listed on the reverse side. No one will be denied admission to
the program due to a medical disability, however participation may be limited if the cadet is not able to meet the medical standards necessary to FULLY participate
in training activities involving strenuous physical exercise and activities such as orientation in fighting shipboard fires in often hot and humid environments. The
medical provider should list any condition(s) that could interfere with full, unrestricted, participation in the NSCC/NLCC. Conditions that will or are likely to require
treatment, particularly unresolved injuries and recurrent illnesses, must be listed. The history of immunization should be verified to the satisfaction of the medical
provider. A licensed medical provider must complete this examination.
1. UNIT INFORMATION
1a. Unit Name
1b. Region
2. PERSONNEL INFORMATION
2a. Last Name
2b. First Name
2c. MI
2d. Social Security Number
2e. Age
2f. Date of Birth (DD MMM YY)
2g. Sex
2h. Parent/Guardian Name
Male
Female
2i. Home Address
2j. City
2k. State
2l. Zip Code + 4
2m. Primary Phone
2n. Alternate Phone
2o. Date of Physical Examination (DD MMM YY)
3. CLINICAL EVALUATION
NOTES: (Describe every abnormality in detail. Enter pertinent item number before each comment)
Anatomy
Normal
Abnormal
3a. Head, Face, Neck, and Scalp
3b. Nose
3c. Sinuses
3d. Ears – General (Internal and External Canals)
3e. Drum (Perforation)
3f. Eyes- General
3g. Ophthalmoscopic
3h. Pupils (Equality and Reaction)
3i. Heart (Thrust, Size, Rhythm, and Sounds)
3j. Lungs and Chest
3k. Abdomen and Viscera (Include Hernia)
3l. External Genitalia (Genitourinary)
3m. Upper Extremities
3n. Lower Extremities
3o. Feet
3p. Spine and other Musculoskeletal
4. LABORATORY FINDINGS (only required for those with a history of urinary tract infections or anemia, enter N/A if tests were not administered)
4a. Urinalysis
4b. Blood
(1) Albumin:
(2) Sugar:
(1) Hemoglobin:
(2) Hematocrit:
5. MEASUREMENTS AND OTHER FINDINGS
5a. Height
5b. Weight
5c. Obese
5d. Pulse
5e. Blood Pressure
(1) Systolic:
(2) Diastolic:
inches
lbs.
Yes
No
5f. Audiogram (if available)
5g. Wears Glasses
5h. Wears Contacts
5i. Uncorrected Vision
HZ
500
1000
2000
3000
4000
6000
(1) Left: 20/
(2) Right: 20/
Yes
No
Yes
No
5j. Color Vision
Right
Left
5k. Other Findings (if more room is needed, continue on reverse)
PREVIOUS EDITIONS ARE OBSOLETE
NSCADM 001 (Rev 08/14), Page 5
Formerly NSCADM 021
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