Annual Health and Medical Record #34605
- Formerly called the 1.a. BSA Medical Exam Form (Class 1, 2 and 3).
- Also know as the: Physical, Medical Exam, Physical Exam, Informed Consent, Hold Harmless, etc.
- Part A: General Information
- Part B: Physical Examination
- Part C: Informed Consent and Hold Harmless/Release Agreement
- Talent Release Form
The Annual Health and Medical Record [Prints on single 8.5 x 11 sheets] [Prints on 11 x 17 sheets] has replaced the Class 1, 2, and 3 forms, which will be phased out in 2009. The use of the new form, No. 34605, will be required effective January 1, 2010, as well as for the 2010 National Scout Jamboree.
The Boy Scouts of America recommends that all youth and adult members have annual medical evaluations by a certified and licensed health-care provider. In an effort to provide better care to those who may become ill or injured and to provide youth members and adult leaders a better understanding of their own physical capabilities, the Boy Scouts of America has established minimum standards for providing medical information prior to participating in various activities. Those standards are offered below in one three-part medical form. Note that unit leaders must always protect the privacy of unit participants by protecting their medical information.
Parts A and C are to be completed annually by all BSA unit members. Both parts are required for all events that do not exceed 72 consecutive hours, where the level of activity is similar to that normally expended at home or at school, such as day camp, day hikes, swimming parties, or an overnight camp, and where medical care is readily available. Medical information required includes a current health history and list of medications. Part C also includes the parental informed consent and hold harmless/release agreement (with an area for notarization if required by your state) as well as a talent release statement. Adult unit leaders should review participants’ health histories and become knowledgeable about the medical needs of the youth members in their unit. This form is to be filled out by participants and parents or guardians and kept on file for easy reference.
Part B is required with parts A and C for any event that exceeds 72 consecutive hours, a Boy Scout Resident Camp or Cub Scout Resident Camp setting, or when the nature of the activity is strenuous and demanding, such as service projects, work weekends, or high-adventure treks. It is to be completed and signed by a certified and licensed health-care provider—physician (MD, DO), nurse practitioner, or physician’s assistant as appropriate for your state. The level of activity ranges from what is normally expended at home or at school to strenuous activity such as hiking and backpacking. Other examples include tour camping, jamborees, and Wood Badge training courses.
It is important to note that the height/weight chart must be strictly adhered to if the event will take the unit beyond a radius wherein emergency evacuation is more than 30 minutes by ground transportation, such as backpacking trips, high-adventure activities, and conservation projects in remote areas.
Based on the vast experience of the medical community, the BSA has identified that the following risk factors may define your participation in various outdoor adventures.
- Excessive body weight
- Heart disease
- Hypertension (high blood pressure)
- Lack of appropriate immunizations
- Sleep disorders
- Muscular/skeletal injuries
- Psychiatric/psychological and emotional difficulties
For more information on medical risk factors, visit Scouting Safely on www.scouting.org.
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 BSA does not mandate or necessarily encourage the leader to do so. Also, if state laws are more limiting, they must be followed.