Adult camper form checklist 1. completed annual bsa health and medical record. a. you complete parts a & b. part c must be completed by a doctor during a physical exam. you can obtain a physical at your regular doctor or go to a place such as care...
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Last name: dob: allergies: emergency contact no.: annual bsa health and medical record part a general information name date of birth age male female address grade completed (youth only) city state zip phone no. unit leader council name/no. unit...
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Troop 134 douglas summer camp - 2011 camp wanocksett 642 upper jaffrey road dublin, nh 03 signup & payment fee for a scout s full week of camp is $340.00. this fee must be paid in full no later than weds, may 18, 2011. medical forms (all pages)...
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Annual health and medical recordsall campers attending either resident or family camp are required to accurately complete and submit theappropriate sections of a current annual health and medical record. any camper arriving without a currentannual...
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Full name: dob: allergies: emergency contact no.: annual bsa health and medical record part a general information high-adventure base participants: %xpedition crew.o orstaffposition name date of birth age male female address grade completed (youth...
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Virginia state omb no. 18200550 expires: 08/31/05 annual state application under part c of the individuals with disabilities education act as amended in 2004 federal fiscal year 2005 cfda no. 84.181a ed form no. 1 b2026p united states department...
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Last name: dob: allergies: emergency contact no.: annual bsa health and medical record part a general information name date of birth age male female address grade completed (youth only) city state zip phone no. unit leader council name/no. unit...
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High-adventure base participants: expedition/crew no.: or staff position: part c to the examining health-care provider (certified and licensed physicians md, do , nurse practitioners, and physician s assistants) you are being asked to certify that...
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5-hole 1/4 1 3/8 c-to-c not a part of medical record pt sticker caregiver sbar correspondence situation ? briefly describe the issue and your concern. background ? pertinent patient parameters assessment ? the assessment of the situation...
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Exhibitor prospe c tus s p e / a p p e a i n te r n at i o n a l c o n fe r e n c e on health, safety and environment in oil & gas explo ratio n and pro duc tio n protecting people and the environment - evolving challenges 11-13 september 2012...
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Tel fono en caso de emergencia allergies: emergency contact no.: fecha de nacimiento alergias full name: dob: parte a nombre completo part a annual health and medical record registro m dico y de salud anual part a/parte a high-adventure base...
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Troop 615 consent for emergency medical treatment and waiver of liability this form is a supplement to part c of the boy scout of america (bsa) annual health and medical record part c, informed consent and hold harmless/release agreement....
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Full name: dob: allergies: emergency contact no.: annual bsa health and medical record part a general information high-adventure base participants: expedition/crew no.: or staff position: female name date of
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