Illustrated Guide to the Scout Medical Form

This page is here to help Parents, Scouts and Scouters understand and fill out the medical form used by Boy Scouts of America for the ScoutsBSA program. The goal is to save time and frustration: Participants (Scouts and Scouters) will NOT be allowed to stay at overnight events unless they have a complete medical form, and the medical form can be complicated to complete, with quite a few details that need to be right.

Step 1 - Get the right form.

Unless otherwise noted, you must be using the most recent official form. It’s called the “Annual Health and Medical Record”, or “AHMR”, and is available online here 📄 as a PDF.

There are many different versions of the form. 99% of the time you need the form listed for “All Participants” — EXCEPT if you’re going to Summer Camp or another overnight event that is longer than 72 hours (such as NYLT or Wood Badge); then you’ll need the form listed under “Are you going to Camp?” The important distinction is in the length of the event - longer than 72 hours - and NOT the length of time the participant will be in attendance. If you’re participating for 1 day of a 6-day event, you still need the longer form. The only difference between the forms is that the longer form adds Part C; the rest of the form (Parts A, B1 and B2) is the same.

Check the bottom-right corner of each page of the form for the “printing”. The most recent “printing” is 2019, and the form you fill out must match. All parts of the form must be the same printing — you cannot use the 2012 printing of Part C with the 2019 printing of Parts A & B.

Filling out the form

The PDF of the form is fillable, so you may type in the information and print it directly — or you may print the blank form and then fill it out by hand. If you fill it out by hand, make sure to use blue or black ink and neat handwriting.

Even though there is a PDF version of the form, the BSA forbids the transmission, collection and storage of medical forms in electronic or digital format. Units may not collect or store forms electronically, and everyone should avoid sending forms via email. Certain camps and events, like summer camp staff or national Jamborees, may collect medical information electronically — but they are systems and situations specifically approved by the BSA that are not available at the Unit level.

Attachments

You may attach additional pages with extra information or where the information will not fit in the space provided. Each attached page should include the Participant’s name and date of birth.

Copies

Please provide at least 2 separate copies of the completed and signed medical form to the Unit — including any extra pages or attachments like the insurance card or list of immunizations. As with all Scouting paperwork, it would be wise to keep a copy for yourself (in addition to the 2 copies you give the Unit).

Units are responsible for safely storing un-expired medical forms and for appropriately destroying expired or otherwise out of date medical forms. Medical forms are kept confidential by the Unit leaders, and are used only to aid the safe participation in Scouting activities.

Form Expiration

A medical form that includes Part C is valid through the end of the 12th month from the date it was administered by your Medical Provider. A medical form that does not include Part C is valid through the end of the 12th month from the earliest date of the signatures on Part A. In other words, if the form was signed on April 4, 2024, then it expires on April 30, 2025.

A medical form will not be accepted if it expires before the end of an event or trip, including events that happen over multiple separate weekends like Wood Badge or NYLT. Likewise, you may be denied participation if your proof of Tetanus immunization would exceed 10 years before the end of the event.

Step 2 - Filling out Part A: Informed Consent, Release Agreement, and Authorization.

The first page of both the short form and the long form is Part A. This form gives permission for the Participant to attend the event, and to be treated in case of medical emergency.

2.1 - PArticipant Name and Date of Birth.

Fill out the full name — including full middle name — and date of birth at the top of this page (and every following page) for the person whose medical form this is.

2.2 Participant Restrictions.

List any activities you do NOT want the Participant to join (such as if you object to the use of firearms or participation in religious services). If there are no restrictions, then make sure the “None” box is checked. The “BB device” checkbox is for the Cub Scout program and not applicable to ScoutsBSA.

2.3 Participant Signature and Date.

The form must be signed and dated by the Participant (that is, the person named at the top of the form). The signature should match the full name at the top of the form, so if the full middle name is included then the signature must also include the full middle name.

⚠️ Get the most out of your form by having the Participant sign and date the form during the same month as the Parent/Guardian (if applicable) and Medical Provider (on Part C, if using long form). ⚠️

If you use the electronic signature features of PDF filling, make sure to ALSO fill in the date on the form — even though the electronic signature should include the date. The medical officer is going to be quickly scanning these forms and will want to see the date in the usual spot on the form, and may not think to check the electronic signature.

2.4 Parent/Guardian Signature and Date.

If the Participant is under age 18, then a Parent/Guardian MUST sign and date the form.

⚠️ Get the most out of your form by having the Parent/Guardian sign and date the form during the same month as the Participant and Medical Provider (on Part C, if using long form). ⚠️

If you use the electronic signature features of PDF filling, make sure to ALSO fill in the date on the form — even though the electronic signature should include the date. The medical officer is going to be quickly scanning these forms and will want to see the date in the usual spot on the form, and may not think to check the electronic signature.

2.5 Adults Authorized to Take Youth to and From Events.

If the Participant is under age 18, fill in the name(s) and phone number(s) of adults OTHER THAN THE PARENTS/GUARDIANS who we are allowed to release the Scout to after an event or during an emergency. For example, if the Participant gets ill on a camping trip and needs to get picked up early, who are the adults allowed to pick up the Participant other than a Parent/Guardian? Or at the end of a camping trip, who are the adults allowed to pick up the Participant other than a Parent/Guardian?

This is a general, long-term permission; for specific or short-term circumstances, the Parent/Guardian may provide separate instructions in writing that are signed and dated.

At least one adult must be provided for all Participants under age 18.

2.6 Adults NOT Authorized to Take Youth to and From Events.

If the Participant is under age 18 and there are one or more adults we are specifically NOT ALLOWED to release the Participant to, please add them to the bottom of the form.

Step 3 - Filling out Part B1: General Information/Health History.

The next part of the form, Part B1, is the demographics and self-reported health history.

3.1 - PArticipant Name and Date of Birth.

Fill out the full name — including full middle name — and date of birth at the top of this page (and every page) for the person whose medical form this is.

3.2 Demographics.

Fill out the Participant’s Age (as of when the form is signed), Gender (preferred), Height in inches, Weight in pounds, Address and primary contact Phone.

3.3 Unit Information.

Put the first and last name and cell phone number for the Scoutmaster of the Participant’s primary Scouting unit.

The “Council Name/No.” is “Cradle of Liberty / 525”.

Fill in the unit number, including “B” or “G”.

3.4 Insurance Information.

Write out the Participant’s primary medical insurance carrier name and policy number.

⚠️ Be sure to include a copy of both the front and back of the Participant’s insurance card with the medical form.⚠️ The copy must be clear enough to read the fine print, especially group id/policy numbers and phone numbers.

3.5 Emergency Contact and Alternate Emergency Contact.

List the name, address and phone numbers for a primary emergency contact as well as an alternate. This should be the long-term usual or typical emergency contact information, typically a Parent/Guardian (for Participants under age 18) or Spouse (for Participants over age 18). If this information will be different for a specific event or trip it should be provided separately for that trip.

3.6 Health History

If the Participant is being, or has ever been treated for any of the listed items, mark the “Yes” box and provide details on the right. You may provide details on another sheet if more space is needed. Any lines marked “Yes” MUST have details provided. Only list items diagnosed by and/or under care of a medical professional.

Step 4 - Filling out Part B2: General Information/Health History.

The self-reported health history continues with Part B2, which covers medication and immunization.

4.1 - PArticipant Name and Date of Birth.

Fill out the full name — including full middle name — and date of birth at the top of this page (and every page) for the person whose medical form this is.

4.2 Autoinjectors and Rescue Inhalers.

Please mark “Yes” if the Participant uses an autoinjector (such as an EpiPen) or asthma rescue inhaler, and note the expiration date for such devices.

Should the device expire before an event or trip, proof of a replacement device with later expiration must be provided.

⚠️Note that Participant will be required to have such (un-expired) devices with or near them for all Scouting events.⚠️

Any devices listed — autoinjector and/or rescue inhaler — must also be listed in the section on medication (4.4, below), and must be in the original container with the pharmacy label showing prescriber, dosage, etc.

4.3 Allergies.

Note any allergies the Participants has. Please list only medically diagnosed allergies or intolerances, rather than preferences. Only list things like “Lactose Intolerance,” “Poison Ivy,” or “Mosquitos” if Participant shows a medically significant and/or dangerous reaction, rather than a “normal” rash or reaction.

⚠️There should be something listed in this section if Participant has an epinephrine autoinjector.⚠️

4.4 Medication.

List all prescription and over-the-counter medication, including autoinjectors and rescue inhalers, that the Participant is prescribed or usually takes. Include the medication name, dose, frequency and reason for taking. If the Participant’s medications ever change: either a new medical form should be created or a written note indicating the changes should be added to the existing form.

The reasons for prescription medications listed should be reflected in the Health History on Part B1. For example, if medication for treatment of ADHD is listed, then ADHD should be included in the Health History. An autoinjector to treat acute allergies should have those allergies listed in the appropriate part of the form.

Make sure to check the box if the Participant is (or is not) allowed to be given common over-the-counter medication like acetaminophen (Tylenol), ibuprofen (Advil), or diphenhydramine (Benadryl) (among other medications) — and if there are any medications to specifically not provide. If there are no exceptions, then fill in “none” or “n/a” on the line provided.

If the Participant is under the age of 18, a Parent/Guardian and/or Medical Provider should sign this section.

Note that any medication brought by a Participant, including autoinjectors and rescue inhalers, MUST be in the original container with appropriate labels that include the Participant’s name, dose and frequency, and the medication may not have expired.

4.5 Immunizations and Other Important Medical Information.

List dates for the Participant’s most recent immunizations.

⚠️ A Tetanus shot (either DTaP or TDaP) within the last 10 years is required. If the 10 years will expire before the medical form does, the Participant may be refused access to the camp or event without further proof of a recent immunization. ⚠️

It is acceptable to attach a separate listing of immunizations as provided by a medical office, such as a print-out from a medical records system, as long as the Participant’s name and date of birth are included on each page of the listing.

There is also a section to list any important medical information not already covered on the form. Examples may include extreme anxiety around the sight of blood or injury, recent foreign travel, or gender identity that differs from sex.

Step 5 - Part C: Pre-Participation Phsyical.

The final part of the long form (not required for the short form) is Part C, where a Medical Provider certifies that the health information on the form is correct.

Part C is only required for events that exceed 72 hours in length. Note that it’s the length of the event, not the Participant’s length of attendance, that governs the need for Part C. So the long form will be required even if the Participant is only attending for less than 72 hours. Events that span multiple separate times under a single registration (such as the two weekends of a Wood Badge or NYLT course) that total above the 72-hour limit also require Part C.

Part C must be signed by a Medical Provider (doctor, nurse practitioner, physician assistant, etc.) who is licensed in the state that the Participant resides in.

⚠️ Get the most out of your form by having the Medical Provider sign and date the form during the same month as the Participant and Parent/Guardian. ⚠️

⚠️The Medical Provider’s signature is saying they agree with and certify the entirety of the form, including Parts A, B1 and B2, as well as Part C. All parts of the form should be provided to the Medical Provider for their review prior to signing.⚠️

5.1 - Participant Name and Date of Birth.

Fill out the full name — including full middle name — and date of birth at the top of this page (and every following page) for the person whose medical form this is.

5.2 Restrictions to Participation.

The Medical Provider should mark and explain any medical restrictions to participation that prevent the Participant from any activities in Scouting.

5.3 Allergies.

The Medical Provider should mark and explain any allergies or severe reactions. This section should largely agree with the similar section in Part B2.

5.4 Vitals.

The Medical Provider should note the Participant’s vitals.

⚠️ This is one of the most-often forgotten things on the medical form; Participants and Parents/Guardians should make sure to remind the Medical Provider to fill out this section. ⚠️

5.5 Medical Summary.

The Medical Provider should mark and explain any medical conditions experienced by the Participant. The medical provider may write “deferred” for any item they did not directly examine at your appointment.

5.6 Certification and Signature.

The Medical Provider should mark their answers to the listed items, and then sign and date the form.

⚠️ Get the most out of your form by having the Medical Provider sign and date the form during the same month as the Participant and Parent/Guardian. ⚠️

Note that the height and weight requirements are only specific for certain High Adventure trips — general camping and Scouting events only require that the Participant is able to safely attend and participate.