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Ds 1843-2026

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The document is a medical history and examination form (DS-1843) issued by the U.S. Department of State for individuals aged 12 and older, aimed at collecting health information necessary for medical clearance to participate in the Department's Medical Program while assigned abroad. It includes sections for demographic information, medical history, current medications, and laboratory analysis requirements. The form emphasizes the importance of providing accurate medical information and outlines the voluntary nature of disclosure, while also detailing legal protections under the Privacy Act and GINA.

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Click ‘Get Form’ to open the ds 1843 in the editor.
Begin by filling out the Demographic Information section. Enter the examinee's name, date of birth, and other required details accurately.
Proceed to the Medical History section. Answer each question truthfully, providing explanations for any 'Yes' responses in the designated box.
List all current medications in Section III, ensuring you include dosage and frequency for clarity.
Complete Section IV regarding hospitalizations and operations. Be thorough in detailing any relevant medical history.
Review your entries for accuracy before signing on page 2. Ensure all necessary laboratory tests are attached as specified.
Submit your completed form via email in PDF format to MEDMR@state.gov or fax it to the Medical Records Department.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (63 Votes)
2017	4.2 Satisfied (77 Votes)
2013	4.4 Satisfied (428 Votes)

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What do they check for medical clearance?

Your provider will check vital signs, listen to your heart and lungs, and assess your overall health. These may include bloodwork, urinalysis, or other labs tailored to your condition and procedure. Depending on your needs, you may be referred for an EKG or chest X-ray to rule out complications.

What does a medical clearance consist of?

Basic Evaluations: Without tests, it may take up to 12 days. Comprehensive Clearances: If lab tests or imaging studies are required, may take several days.

How long does a medical clearance take?

The Department of State has identified certain posts as Employee Self-Certification and Ability to Perform in Emergencies (ESCAPE) posts. ESCAPE posts comprise a subset of High-Threat, High Risk (HTHR) posts.

How to prepare for medical clearance?

Review your medication list, with recommendations for how to take your medications prior to surgery. Review your medical, surgical and family history. Include a physical exam. If necessary, complete additional preoperative testing following your exam, including blood tests, tests, X-rays or an EKG.

What is an escape post?

A medical clearance enables these individuals to access Department health care benefits and services while posted abroad. Benefits include, but are not limited to, access to the post Health Unit, medical evacuation travel, and secondary payer coverage for hospitalizations.

ds 1843 instructions

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What do you need for a medical clearance?

A: Confirmation Receipt from Online Booking. One (1) Fully Accomplished BOQ PE Form 2: Medical Exam for Local Applicants (To be filled up at BOQ) 11 ID Picture with White Background (Three (3) pieces for New Application and Two (2) pieces for Renewal) Previous Health Card (For Renewal Only)