Ds 1622-2025

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The document is a medical history and examination form (DS-1622) for children aged 11 and younger, required by the U.S. Department of State for medical clearance in the Foreign Service. It collects demographic information, medical history, current medications, and details about any hospitalizations or operations. The form emphasizes compliance with privacy laws and outlines the voluntary nature of providing information, while noting that failure to do so may affect medical clearance. Additionally, it includes instructions for completion and submission.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (193 Votes)
2017	4.3 Satisfied (126 Votes)
2002	4.3 Satisfied (422 Votes)

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How to get medically cleared?

Fill out the DS-1843 form. Fill out the DS-6570 (Pre-Deployment Physical Acknowledgement form). Have a medical provider conduct a physical examination and complete and sign the DS-1843 and DS-6570. Submit the completed DS-1843 and DS-6570 via email as a PDF to MEDMR@state.gov or fax it to 202-647-0292.

How long does a medical clearance last?

Pre-Employment/Post-Offer exam results are generally valid for 12 months from the date of the examination, with the exception of POST positions, which strictly require the exam to have been conducted within the 12-month period prior to the applicants start date.

How long is a medical record release good for?

Theres no statutory time period within which a release must expire. However, under HIPAA, an authorization to release medical information must include a cutoff date or event that relates to whos authorizing the release and why the information is being disclosed.

What do they check for medical clearance?

The medical clearance is based upon the employee participating in a complete head-to-toe physical examination, a complete blood panel, a health history questionnaire, an EKG, vision test, pulmonary function test, hearing test, and a stress test for those over the age of 40 or at the discretion of the provider.

How to get a medical clearance letter?

Obtain the Medical Clearance Form from your healthcare provider or the institution requiring it. Fill in your personal information, including your name, date of birth, and contact details. Provide details of your medical history, including any existing conditions, medications, and previous surgeries.

How long is a medical clearance good for?

How long is my medical clearance valid? A medical clearance is valid until the end of a tour or home leave, whichever is shorter, unless there is a significant change in the individuals medical condition [16 FAM 214b].

What is a worldwide available medical clearance?

A Class 1 medical clearance, also referred to as a Worldwide Available medical clearance, is issued to individuals who have no identifiable medical conditions that would limit their assignment abroad. See 16 FAM 211.2(a).

How long does a medical clearance take for a job?

However, notice of the applicants medical status from the contracted clinic may take up to 10 business days from the date of the medical examination. In some cases, the process can be extended longer due to the need to review and consider additional information or personal medical records from the applicant.

Ds 1622-2025

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