Asthma Consent Form - Adventure Training (for GP)

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ACP 237 (11th Edition) APPENDIX 3 TO ANNEX E TO ACP 237 CHAP 4 ADVENTUROUS TRAINING - MEDICAL CERTIFICATE - ASTHMATICS Certificate to be completed by the applicants GP. Name of applicant _____________________________________________________________________ I have reviewed the above mentioned who is at lower/higher risk* (Note 1) for fitness to participate in the adventurous training activities organised by the Air Training Corps for the period ________________ to __________________ . I find the cadet, in accordance with the criteria set out below, fit to take part in all activities/unfit to participate in the following activities: (Note 2)*__________________________ Date _________________________________

Signature __________________________________

* Delete as appropriate

Name _____________________________________

Note 1: Lower risk for adventurous training (AT): 1. Those asthmatics who have never required hospital or emergency treatment for their asthma, and who have: a.

Never needed oral steroids (tablets) or nebulised bronchodilators.

b. Not required preventative treatment with inhaled steroids or cromoglycate within the previous 2 years. c. Required no more than 8 doses of a bronchodilator (inhaler) a month (except as pre-dosing before sport). 2. The applicant should be able to run one mile without stopping or dosing with bronchodilator and the pre-bronchodilator Peak Expiratory Flow Rate should be within 15% of the medically predicted rate. Higher risk for AT constitute those whose asthma falls outside the definition of lower risk above. Note 2: Enter numeral indicating type of activity: 1: 2: 3: 4: 5: 6: 7:

Rock Climbing, mountaineering and mountain walking Top Roping and abseiling Canoeing Snow skiing Caving AEF flying/gliding Offshore sailing

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