Ds 3057-2026

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The document is a medical clearance update form from the U.S. Department of State's Office of Medical Services, intended for employees and their family members assigned overseas or domestically. It collects personal and medical information to facilitate appropriate medical clearance decisions, ensuring compliance with privacy laws and regulations. The form includes sections for demographic details, current medications, medical history updates, and specific instructions for pregnant women and children. It emphasizes the importance of accurate information and outlines potential consequences for omissions or falsifications.

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Click ‘Get Form’ to open the ds 3057 in the editor.
Begin by filling out the demographic information on page 1. Enter your name, date of birth, and sex in the designated fields.
Provide your MED ID number if available, and indicate your place of birth along with your status (Employee, Spouse, Dependent Child).
Complete the health insurance details and agency information. Ensure you include your mailing address and contact information for the next 90 days.
On page 2, list any current medications and update your medical history as required. Be sure to answer all questions thoroughly.
After completing all sections, review your entries for accuracy before signing the form at the bottom of page 2.
Finally, scan the completed form and email it in PDF format as instructed or fax it if scanning is not possible.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (91 Votes)
2017	4.4 Satisfied (107 Votes)
2014	4.3 Satisfied (42 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How long does a medical clearance take?

It is difficult to tell how long a pre-employment check will take because not all of them are done in the same way, and it also depends on the number of tests required. Nevertheless, it can take 3 to 4 weeks on an average.

What does being medically cleared mean?

The term is often used by surgeons requesting a medical evaluation before performing surgery on a patient. In the context of surgery, a medical clearance is, essentially, considered to be an authorization from an evaluating clinician that a patient is cleared, or deemed healthy enough, for a proposed surgery.

What does a medical clearance exam consist of?

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 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.

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.

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How do I prepare for medical clearance?

A successful clearance and surgery starts with a good preparation Signup Book your visit. Answer a set of questions to prepare your visit. Get your test done when you want with Quest or Labcorp. Get your clearance letter after a telehealth visit. Get 24/7 access support before your surgery. And after your surgery.

Ds 3057-2026

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