| Document Date: 2010-07-03 17:14:28
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City Irving / / Continent America / / IndustryTerm insurance / ground transportation / / MedicalCondition Allergies / Explain Allergies / ADHD / Hypertension / disease / MEDICAL HISTORY Allergies / Seizures / Fainting / Muscular/skeletal injuries / Measles / disease Seizures Sleep disorders / Tetanus / Heart disease / Diabetes / Allergies/anaphylaxis / Polio / seizure / emotional difficulties Learning disorders / sleep apnea / Chicken pox_______________________ Hepatitis A_________________________ Hepatitis B_________________________ Influenza / high blood pressure / No Date Tetanus_____________________________ Pertussis / Mumps_____________________________ Rubella / disorders / Asthma / / MedicalTreatment immunization / immunizations / Surgery / / Person TIA COPD / / Position Governor / leader / GENERAL INFORMATION Name / nurse / physician / assistant / Unit leader / / Product EpiPen / No Condition Explain Medication / Temporary Permanent Medication / / ProvinceOrState Texas / / Technology cellular telephone / CAD / / URL www.scouting.org / www.cdc.gov / http /
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Annual Health and Medical Record (Valid for 12 calendar months) Medical Information The Boy Scouts of America recommends that all youth and adult members have annual medical evaluations by a certified and licensed health