A wildland firefighter whose screening or OF-178 exam shows an immune system or allergic disorder brings this template to the treating provider. Part B captures diagnosis, medications, stability, emergency visits, surgeries, splenectomy immunization status and allergy triggers, and a Forest Service Medical Officer uses it to decide medical clearance or a waiver for fireline or support work.
The employee completes Part A with name, date of birth, home unit and Light, Moderate or Arduous fitness level, which also authorizes release to the program's Medical Officers. The treating provider (MD, DO, NP, PA or other) completes Part B and signs with an office stamp.
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USDA Forest Service: Fire Medical Qualifications Program - Immune System/Allergic Disorder
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The Medical Officer needs to judge whether the condition is static and stable before a waiver can be considered. Part B asks how many events in the past five years required emergency room or urgent care treatment, alongside the medication list and the provider's view on stability and compliance with ongoing care.
Only a Forest Service Medical Officer grants waivers. The provider's template is evidence, not the decision. A waiver can carry mitigation requirements, such as sending updated information each year or reporting a change in condition, and the employee must meet them to keep the waiver valid.