Medical History and Examination Form for Adults
The Medical History and Examination form is required for individuals aged 12 and older seeking medical clearance. This form gathers demographic data, health history, and medication information. Proper completion is essential for efficient processing of medical evaluations.
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How do I fill this out?
Filling out this form requires careful attention to each section. Begin by providing your personal information, followed by detailed medical history and current medications. Ensure all answers are complete and accurate to avoid delays in processing.
How to fill out the Medical History and Examination Form for Adults?
1
Read the instructions carefully before starting.
2
Fill out your demographic information accurately.
3
Complete the medical history section with honest answers.
4
List all current medications, including over-the-counter drugs.
5
Sign and date the form to validate your submission.
Who needs the Medical History and Examination Form for Adults?
1
Individuals applying for a job with the U.S. Department of State.
2
Family members of U.S. government employees seeking medical clearance.
3
Contractors working with government agencies requiring medical evaluations.
4
Employees returning from overseas assignments needing health assessments.
5
Adoptive parents completing required medical paperwork for children.
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Select the section you wish to edit and make your changes.
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Save your edits to ensure your changes are recorded.
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Review the entire document for accuracy after editing.
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Download the edited PDF to your device for submission.
What are the instructions for submitting this form?
To submit this form, complete all sections and ensure accuracy throughout. You can send your completed form via email to the designated medical clearance office or fax it to the respective department. If submitting physically, mail it to the U.S. Department of State, Bureau of Medical Services, Room L101, SA-1, Washington, DC 20522-0102. For the best processing experience, check with your HR department for any additional specifics on submission protocols.
What are the important dates for this form in 2024 and 2025?
The Medical History and Examination Form (DS-1843) must be submitted before your scheduled medical evaluation. Be aware of the approval expiration date: April 30, 2026. Ensure you submit any required paperwork in advance to avoid delays.
What is the purpose of this form?
The primary purpose of the Medical History and Examination form is to gather comprehensive medical data from individuals who are applying for positions or assignments with U.S. government agencies. This information is crucial for ensuring that health considerations are taken into account when evaluating candidates for positions abroad. By collecting this data, the Department of State can make informed decisions about an individual's fitness for duty via its medical clearance process.
Tell me about this form and its components and fields line-by-line.
- 1. Name of Examinee: Full name of the examinee.
- 2. Date of Exam: Date when the medical examination takes place.
- 3. DOB: Date of birth of the examinee.
- 4. Gender Identity: Options for specify gender identity.
- 5. Medical History: Section to answer questions regarding medical history.
- 6. Current Medications: List of all medications currently being taken.
- 7. Hospitalizations: Details about any hospital stays or operations.
- 8. Signature: Signature of the examinee or parent.
What happens if I fail to submit this form?
Failure to submit this form may result in delays or rejection of your medical clearance application. It is important to understand that incomplete or inaccurate forms can lead to additional requests for information or clarification. Ensuring timely submission is crucial to your application process.
- Delays in Processing: Incomplete forms may lead to delays in processing your application.
- Rejection of Clearance: Missing information could result in the rejection of your medical clearance.
- Need for Additional Information: You may be contacted to provide further information or clarification.
How do I know when to use this form?
- 1. Job Application: When applying for a position with the U.S. government.
- 2. Overseas Assignment: Needed for individuals moving or working abroad.
- 3. Family Member Clearance: Required for family members accompanying government employees.
Frequently Asked Questions
What is the purpose of the Medical History form?
This form is used to gather necessary medical information for individuals applying for a medical clearance.
How can I fill out the form online?
You can fill out the form using our PDF editor by selecting text fields and entering your information.
Is it necessary to provide all medical history?
Yes, it is crucial to provide complete and accurate medical history for proper evaluation.
Can I download the completed form?
Yes, after editing, you can download the completed PDF directly to your device.
What should I do if I have a question about a section?
Please refer to the instructions or consult a medical professional if unsure.
Can I share the PDF with others?
Absolutely, you can share the PDF with others via email or by sharing links.
How do I sign the PDF?
You can use the electronic signature feature within PrintFriendly's editor to sign the document.
Is there a limit to the number of edits I can make?
No, you can make as many edits as you need before finalizing the document.
What if I forget to fill out a section?
Be sure to review the form thoroughly to avoid missing any required sections.
How does this form impact my application process?
Submitting this form ensures that you meet the health requirements for your application.
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