I further authorize the sharing of the information on this form with any bsa volunteers or professionals who need to know of medical conditions that may require. Vital records forms updated march 18, 2014, pdf 25k. The downloadable, fillable pdf forms available on this page have been modified to comply with the section 508 requirement that website content be accessible to people with disabilities. Northeast pennsylvania council, boy scouts of america. The dd form 2792 and attached addenda are completed to identify a family member with special medical needs.
Informed consent, release agreement, and authorization. Please send your comments or questions to va forms managers. Department of labor employees serious health condition wage and hour division family and medical leave act. If this message is not eventually replaced by the proper contents of the document, your pdf viewer may not be able to display this type of document. Aas22, adult medical day care inspection information, pdf 31k doc 73k. Page 1 form wh380e revised may 2015 certification of health care provider for u. Annual health and medical record boy scouts of america. Ccfrm0 11 e call covered california at 18003001506 y 18888800. Annual health and medical record the scouting adventure, camping trips, highadventure excursions, and having fun are important to everyone in scoutingand so is your safety and wellbeing.
Internal revenue service department of the treasury. Health insurance marketplace application for exemption. Completing the annual health and medical record is the first step in making sure you have a great scouting experience. Medical providers and billers may view and download the following forms. Dd form 2792, family member medical summary, august 2014. Your destination for affordable health insurance, including medical state of california health insurance application 11 ccfrm604. Form 1040 department of the treasury internal revenue service 99 u.
The worksheet on page 4 and the charts beginning on page 5, used to compute withholding allowances or to enter an additional dollar amount on lines 3, 4, or 5, have been revised. Rollins pond base campsites are only used in case of overflow. Ssa150 10 2014 ef 10 2014 social security administration. Ics forms emergency management institute ics fillable. Including the dan beard district and the two mountains district.
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