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USFS Fire Medical Form: Gastrointestinal Conditions

A Forest Service fire employee with a gastrointestinal condition brings this template to their treating provider when the medical review flags it. Part B asks for the diagnosis, medications, whether the condition is stable or in remission, how often and how badly it flares, related surgeries and return-to-duty dates, any ostomy, and whether the employee can take in enough calories and fluids on a fire assignment.

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

  • The nutrition question asks about consuming enough calories and fluids in a wilderness fire environment over 100°F, with an elevated dehydration risk and definitive care more than an hour away.
  • If the employee has an ostomy, note where it is located, whether it is permanent or temporary, and the reversal date.
  • List any surgeries with the date of surgery and the date the employee returned to full, unrestricted work duties.
  • A waiver is only considered for a condition that is static and stable, and mitigations may require yearly updates or notice of any change.

Get the official form

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

USDA Forest Service: Fire Medical Qualifications Program - Gastrointestinal

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Frequently asked questions

What does the Forest Service gastrointestinal medical form ask?

Part B asks the diagnosis, medications and their indications, whether the condition is static and stable or in remission with good compliance, the frequency and severity of exacerbations, related surgeries and return-to-duty dates, ostomy details, and any concerns about calorie and fluid intake in hot, remote fire conditions.

Can a wildland firefighter with an ostomy be cleared by the Forest Service?

The template asks the treating provider where the ostomy is located and whether it is permanent or temporary, with a reversal date if planned. A Forest Service Medical Officer weighs that with the rest of Part B to decide qualification or a waiver; the provider does not make that decision.

What conditions come with a Forest Service medical waiver?

The Fire Medical Qualifications Program says a waiver applies to static, stable conditions and may come with mitigations, such as yearly updates, evidence that the condition remains stable, or notice of any change. A Forest Service Medical Officer sets the mitigations for each employee.