Order Of The Arrow - Boy Scouts Of America Health And Medical Record Form

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(Meets BSA Class 3 Physical Requirements)
Information for the Examiner and the Applicant
This physical form has been designed to address some concerns and limitations that may be experienced by combining any
existing or other potential medical condition(s) with the strenuous activities and various environmental stressors in these
potentially arduous environments.
The ArrowCorps
project is the 2008 national program of emphasis for the Order of the Arrow, Boy Scouts of America. During
this week long program, the participants and staff will be performing several strenuous service projects for the United States
Forestry Service and will be exposed to the climatic changes and challenges found within five of our nation’s great majestic
National Forests. While living and working in these environments, their bodies will be stressed and challenged. Some of the
conditions that they may face are: temperatures varying between 30-110 degrees (Fahrenheit), altitudes of sea level up to 8,000
feet, long days of strenuous outdoor activities, and various food restrictions and limitations. Therefore, if the participant or staff
member has a pre-existing medical condition(s) which may be adversely affected by these factors, special consideration needs to
be given to determine if they should participate. Another aspect to consider clearance for participation is limited access to care.
The various remote program sites will have limited capabilities for healthcare; in some remote locations there may be a significant
delay until definitive care may be delivered.
Each physical examination must be completed within 12 months prior to the start of
Each participant and staff member will be held to the same standards for medical clearance in order to provide them with the
safest and most complete preventative health screening. They will also be required to follow the safety guidelines found in their
information packets. Anyone with the following conditions will not be allowed to participate in the back country
activities. There may be a limited number of staff positions available in the base camp areas for people with these conditions,
but approval for attendance must be obtained from the Incident Commander and the Medical Director from that location.
Inquiries for this waiver must be submitted to the Incident Commander for each ArrowCorps
Everyone who attends the
Program will undergo a medical screening upon their arrival at their
site. If the requirements of this form are not met, the participant or staff member will not be allowed to
participate and will be turned away.
Cardiac and Cardiovascular Illness
A participant or staff member who has any of the following conditions is required to have a complete evaluation by his/her
physician. A letter from the practitioner specifically allowing the participant or staff member to take part in ArrowCorps
must accompany this form. The letter must specify the condition and any limitations. A statement which says “The patient
knows his limitations.” will not be accepted.
1. Angina
2. Myocardial Infarction (heart attack) within the past year
3. Heart Surgery of any type, (congenital heart disease, bypass surgery, or valve surgery)
4. Heart Procedures within the past year (Cardiac Catheterization, PTCA, Arterial Stent Placement, Pacemaker, and Internal
Cardiac Defibrillator)
5. Stroke or Transient Ischemic Attacks
6. Extremity Claudication
7. Family History of Heart Disease and sudden death before the age of 50
8. Congestive Heart Failure
It is recommended that these patients have a stress test performed within the six months immediately prior to attending this
program. It is also highly recommended that the patients with implanted devices (pacemaker and Internal Cardiac Defibrillators)
have their devices checked within six months of the event. Please keep in mind that, even if the tests are negative the multiple
stressors on the body may still precipitate problems and the patient will not have immediate access to definitive care due to the
remote location of the program sites.
Hypertension has the potential to create multiple complications for those who their hypertension is not well controlled.
Unfortunately, the strenuous environment of this program (climatic, altitude, and physical) has the potential for significantly
worsening or complicating a patient’s hypertension. This could result in, and not limited to, an Acute Coronary Syndrome, an


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