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Forest Service Hypertension Form: Fire Medical Waiver

The Forest Service Fire Medical Qualifications Program sends this template when a wildland firefighter's health screening or OF-178 exam raises high blood pressure, an aneurysm or another vascular condition. The treating provider reports diagnosis, medications, stability and procedures so a Forest Service Medical Officer can decide medical clearance or a waiver for the employee's Light, Moderate or Arduous position.

Who completes it

The employee fills in Part A (name, date of birth, home unit and fitness level) and, by handing it over, authorizes release to the program's Medical Officers. The treating MD, DO, NP or PA completes Part B as applicable, signs and adds an office stamp.

Submitting and payment

How to submit it
The provider faxes the completed form to the Fire Medical Qualifications Program office, using the fax line printed on Part B. The page sets no day count, so follow the deadline in the employee's eMedical request.
Who pays
There is no agency fee schedule; the Forest Service tells employees it is their responsibility to obtain, pay for and supply medical documentation the Medical Officer requests (5 CFR 339.304(c)).

Good to know

  • Part B asks for the employee's average blood pressure, a complete medication list with indications, and whether the condition is static and stable with good compliance with care.
  • For an aneurysm, record its location, size, the date of the last measurement and how often it is imaged; other vascular conditions need date diagnosed, treatment and prognosis.
  • List surgeries or procedures for the diagnosis with the procedure date and the date the employee was released back to full work duties.
  • The final question asks about restrictions for 16-hour shifts up to 21 days in a row, heat over 100°F or below 32°F, altitude above 5,000 feet, smoke and care over an hour away.

Get the official form

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

USDA Forest Service: Fire Medical Qualifications Program - Hypertension/Aneurysm/Vascular

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

Does the provider decide whether the firefighter is medically qualified?

No. The Forest Service states that the employee's medical provider does not make the final determination. The provider documents diagnosis, blood pressure, treatment and any restrictions, and a Forest Service Medical Officer reviews it. Only the Medical Officer can grant a waiver, and a waiver is considered only when the information shows the condition is static and stable.

What do the Light, Moderate and Arduous levels on the form mean?

They are the work capacity test levels described on the form's last page. Arduous is a 3-mile hike with a 45-pound pack in 45 minutes, Moderate is a 2-mile hike with a 25-pound pack in 30 minutes, and Light is a 1-mile hike with no load in 16 minutes, following NWCG PMS 310-1.

When is the hypertension/aneurysm/vascular template requested?

After the employee's Health Screening Questionnaire or OF-178 exam reaches a Forest Service Medical Officer, the program may send a Request for Information asking for more documentation about a diagnosis. For blood pressure, aneurysm or vascular findings, this template is the document the employee brings to the treating provider.