Cadet - Report of Medical History - Page 3 & 4

The Report of Medical History is to be completed by a parent or guardian, and shall be used to disclose all medical conditions, mental health conditions, hospitalizations or institutionalization, allergies, and immunizations.

• The Report of Medical History must be updated:
  1. annually upon re-enrollment;
  2. upon any change to physical or mental health history; and
  3. within 30 days of reporting to any NSCC or NLCC training.

•  If no changes have taken place in the cadet’s medical history since the last update, a parent or guardian may update the Report of Medical History by
  1. printing the date, printing “NO CHANGES,” and 
  2. signing his or her name underneath the original signature block.

• The Report of Medical History must include a current list of all immunizations or proof of vaccinations.

Prior to enrollment, and no less frequently than once per annual enrollment period, all cadet applicants must receive a physical examination (sports-type) and report the results to their Unit CO. This examination is to be conducted by a physician, physician’s assistant, or nurse practitioner. The Report of Medical Examination form will be used to record the results of this exam. A form from the provider’s office cannot be substituted for the Report of Medical Examination form because other forms may not record all of the information required, and the Report of Medical Examination form contains all required medical information in a format familiar to any first-responding US personnel. The evaluating clinician should note any reason why the applicant may not fully meet the enrollment criteria.

• The Report of Medical Examination with a medical provider’s endorsement must be updated:
  1.  once in each enrollment period, with no more than 15 months between exams; and
  2. upon any significant change to physical or mental health, to include major injuries, major illnesses, surgeries, concussions, hospitalizations, institutionalization, or instances of self-harm or attempted self-harm.

Prior to enrollment, cadet applicants who may require regular administration of any prescription or non-prescription medication during unit drills must submit a completed Medical History Supplemental. This form includes information about the medications, their dosing, instructions for administration, side effects, contraindications, and consequences of missing a dose. For over-the-counter medications, the form needs only be signed by a parent or legal guardian and the unit Commanding Officer. For prescription medications, the form must also be signed by the prescribing medical provider. Cadets who do not require medications shall submit the Medical History Supplemental form signed by a parent or guardian upon enrollment, with “N/A” written across the front.

• The Medical History Supplemental must be updated:
  1. whenever there is a change in a medication, dosing, or administration instructions; and
  2. each time a cadet is attending a training

• An updated Medical History Supplemental shall be forwarded to the COTC with the NSCTNG 001 Request for Training Authority each time a cadet requiring medication wishes to attend an NSCC or NLCC training.

As described in USNSCC Regulations, Section 5.02, and Section 0110 below, the USNSCC accepts qualified applicants who, because of a disability, require some reasonable accommodation to non-essential policies and procedures in order to meet all requirements of membership in the USNSCC.

• To ensure that all volunteers that may be responsible for a cadet’s training, health and safety are aware of the cadet’s needs, all disabilities must be fully and honestly documented on the NSCADM 001 (Pages 9/10), Request for Accommodation form.

• The Request for Accommodation form must be signed by the parent or guardian, Unit Commanding Officer, cognizant Regional Director, and cognizant NHQ Representative. Cadets who do not require an accommodation should still submit this form signed by a parent or guardian upon enrollment, with “N/A” written across the front.

• A Request for Accommodation form must be forwarded to the COTC with the NSCTNG001 Request for Training Authority each time a cadet requesting accommodations wishes to attend an NSCC or NLCC training.

• Upon completion of the Request for Accommodation form, the unit CO will:
  1. Forward the completed form to the NHQ Representative, via the Regional Director. The NHQ Representative has approving authority for all ADA accommodation requests.
  2. If the CO or RD believes that a requested accommodation is not reasonable (see USNSCC Regulations, Section 5.02(c)) he or she will add a negative endorsement and forward it to the NHQ Representative for final decision. If the NHQ Representative concurs that the requested accommodation is not reasonable, the applicant is deemed not qualified and cannot enroll.