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USFS Fire Medical Form: Diabetes and Prediabetes

A Forest Service fire employee with prediabetes or diabetes brings this four-page template to their treating provider after the medical review flags the condition. Part B covers the diabetes type, medications, stability, glucose monitoring, A1C goals and history, insulin pump backup plans, severe hypoglycemia, end-organ damage and vision. Forest Service Medical Officers use it to decide qualification or a waiver for fire duties.

Who completes it

The employee completes Part A (name, date of birth, home unit and light, moderate or arduous fitness level), which also authorizes release to Forest Service Medical Officers. The treating provider (MD, DO, NP, PA or other) completes Part B as applicable and signs it with an office stamp.

Submitting and payment

How to submit it
Fax the completed form to the Fire Medical Qualifications Program office as printed on the form; the program also receives documents through the employee's eMedical account.
Who pays
When a Medical Officer requests more medical information, the employee must obtain, pay for and supply it under 5 CFR 339.304(c).

Good to know

  • Supply the past year's A1C values, or a screenshot or percentage of continuous glucose monitor time in range for the last 90 days with the target range.
  • If the A1C goal is above 7.0% for type 2 or 7.5% for type 1 diabetes, the form asks you to explain the higher target.
  • The Forest Service defines a severe hypoglycemic episode as one needing another person's help or causing loss of consciousness, seizure or coma; give the date of any in the past 12 months.
  • End-organ questions ask whether neuropathy or limb problems are compatible with duties that may include walking on, or searching by hand for, hot ground that can melt a boot sole.

Get the official form

Download the current version from the source each time; forms change without notice.

USDA Forest Service: Fire Medical Qualifications Program - Diabetes Mellitus/Pre-Diabetes

Official pagePDF

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

What diabetes types does the Forest Service fire medical form cover?

Part B lists prediabetes, type 1, type 2, MODY, gestational diabetes, LADA and type 3c. The same template asks for medications, whether the condition is static and stable with good compliance, CGM use, glucose testing frequency and how often you require an A1C.

Does the Forest Service need CGM data for a firefighter with diabetes?

Not necessarily. The form accepts the employee's A1C results for the past year, a screenshot of the CGM's last 90 days of time in range, or a written percentage of time in range with the range used.

What counts as severe hypoglycemia on the USFS diabetes form?

The Forest Service defines a severe episode as one that requires the assistance of others to correct, or results in loss of consciousness, seizure or coma. Mark whether one happened in the preceding 12 months and, if so, give the date.