Bsa Personal Health And Medical Record Form Class 3 Page 4
Download a blank fillable Bsa Personal Health And Medical Record Form Class 3 in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Bsa Personal Health And Medical Record Form Class 3 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4VII.HEALTH EXAMINATION
Licensed Health-Care Practitioner:
The applicant will be participating in a strenuous activity that will include one or more of the following conditions:
athletic competition, adventure challenge or wilderness expedition (afoot or afloat) that may include high altitude,
extreme weather conditions, cold water, exposure, fatigue, and/or remote conditions where readily available medical
care cannot be assured.
• Please insist applicant furnish complete medical history (VI) before exam.
• Review immunizations; for youth (18) or younger) tetanus and diphtheria toxoids, measles, mumps, and rubella
vaccines, and trivalent oral polio vaccine are required; youths and adults must have had tetanus booster within 10
years. A measles booster is recommended at age 12.
• After completing section VII, summarize any restrictions and/or recommendations in sections II and V, and sign.
VISION:
HEARING:
Date ______________________________________
Normal__________
Normal___________
Ht.____________________WT.________________
Glasses__________
Abnormal_________
B.P._______/__________Pulse_________________
Contacts_________
Check box if normal; circle if abnormal and give details below:
Growth, development
Teeth, tonsils
Genitourinary
Skin, glands, hair
Respiratory
Skeletomuscular
Head, neck, thyroid
Cardiovascular
Neuropsychiatric
Eyes, ears, nose
Abdomen, hernia, rings
Other (specify)
COMMENTS
_________________________________________________________________________________
FOR THOSE ATTENDING PHILMONT OR NATIONAL HIGH-ADVENTURE BASES:
* The minimum age for all participants is 13 by January 1 of the year of participation, or have completed the seventh
grade. No exceptions.
† Trail food is by necessity a high carbohydrate, high calorie diet. It is high in wheat, milk products, sugar, corn
syrup, and artificial coloring/flavoring. Dinner meals contain meat. If these food products cause a problem in your
diet, you need to bring appropriate substitutions with you and so advise base personnel.
Note: Licensed health-care practitioners representing high-adventure bases reserve the right to deny access to the
trails or other program activity on the basis of a medical evaluation performed at the base after arrival.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business