BSA Annual Health and Medical Record Information

Scouts and adults that participate in any scouting event, including campouts and day events, must turn in up-to-date Boy Scout medical forms to the troop.  A copy of the form can be found here: BSA Annual Health and Medical Record Form

For day events and weekend campouts, parts A and B (3 pages total) must be filled out completely. You do not need to include Part C, the only one requiring a doctor’s signature. Please include a copy of your health insurance card.  Scouts will not be allowed to attend a campout without a current medical form.

For campouts longer than 72 hours, parts A, B, and C (4 pages total) are required.  This includes summer or winter camp.  Please include a copy of your health insurance card. No scout will be allowed to remain in camp without a health history that includes a parental signature giving permission to treat in an emergency.

Part C must be completed, signed, and dated by a certified and licensed physician (MD, DO), a nurse practitioner, or a physician’s assistant.  In-store clinics at some pharmacies (Walgreen’s, CVS) have practitioners who can conduct this brief exam and sign the form.

Carefully follow the instructions below when filling out the forms.

You can either email the forms to me at bertadkins@comcast.net (follow the procedure below for best results), or bring them to any Troop 11 event.  Please email me if you have any questions.

Completing the BSA Health and Medical Record Form

Part A (page 1) and Part B (page 2 and 3) are required for all Scouts and adults participating in any Scouting event. This is filled out and signed by a youth’s parent or guardian or by an adult participant.

Part C (page 4) is required for participation in events lasting longer than 72 hours, including Summer Camp.  Part C must be completed, signed, and dated by a certified and licensed physician (MD, DO), a nurse practitioner, or a physician’s assistant.  In-store clinics at some pharmacies (Walgreen’s, CVS) have practitioners who can conduct the brief exam and sign the form.

Important: If you are taking the Scuba Diving Merit Badge, your doctor must certify this item: “If less than 18 years of age and planning to scuba dive, does not have diabetes, asthma, or seizures.”

Make sure you use the most recent (2014) form.  Here is the url of the link above: http://www.scouting.org/filestore/healthsafety/pdf/680-001_abc.pdf

  • On Part A (page 1) in the right-hand column, make sure any “participant restrictions” are listed or the “none” box is checked.  Please date and sign this page (the scout does not have to sign).
  • On Part B (page 2), our Unit Leader is Sean O’Connor, our Council Name is the Sam Houston Area Council, and our Unit No. is Troop 11.
  • On Part B (page 3), make sure you fill out whether non-prescription medications are authorized and sign where indicated (a doctor’s signature is not needed).  This is only required for scouts, not adults.
  • Including an updated copy of your immunization record is recommended and will save you from having to fill out the immunization chart on page 3.
  • A photocopy of both sides of your Health Insurance Card is required if you have health insurance.

Since the form must be signed, here is the best procedure:

  1. Fill out the form online and save the PDF for your records
  2. Print out the form (and fill it out, if you didn’t do it online) and sign it
  3. Scan the signed form and email it to me with a copy of your insurance card and immunization record (I do not need a hard copy if you email these to me), or
  4. Bring the completed form to a Troop event with a copy of your insurance card and immunization record and give it to Bert Adkins