Foreign Service and other U.S. government employees, applicants and eligible family members aged 12 and older need a State Department medical clearance before an overseas assignment. DS-1843 is the history and physical the examinee's own provider completes for that decision, with required labs attached. The Bureau of Medical Services (MED) reviews it and decides the clearance.
The examinee, or a parent for a minor, completes pages 1 to 3 and signs page 3. The medical examiner completes Sections VIII to XIII on pages 4 and 5: history comments, clinical evaluation, physical exam, labs, assessment and recommendations, then signs page 5.
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Medical History and Examination for Individuals Age 12 and Older
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Yes. The form is completed by the examinee's own physician or other health care provider acting as medical examiner. The examiner must comment on positive history, describe abnormal findings, give follow-up recommendations and sign page 5. Lab reports must be in English and labeled with the examinee's full name and date of birth.
No. The form notes that the history and physical are used to make a medical clearance decision based on anticipated medical needs while living or traveling abroad, and that it does not meet the requirements of an age-appropriate wellness exam. It is a clearance exam with its own lab and TB testing requirements.
The State Department and other agencies whose staff serve abroad under chief-of-mission authority. The form's agency boxes list State, FCS, FAS, the U.S. Agency for Global Media, DoD civilians and contractors, other government agencies and contracting companies, and cover employees, applicants, spouses and dependent children.