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Medical Clearances United States Department of State  Form

Medical Clearances United States Department of State Form

Use a ds 1843 template to make your document workflow more streamlined.

FedEx or DHL. U.S. Department of State Bureau of Medical Services Room L101 SA-1 Washington DC 20522-0102 OMB APPROVAL NO. Date of last PAP test 36. Date of last Mammogram 37. Are you pregnant Results No Est. due date Date Test colonoscopy/sigmoidoscopy/guiacFOBT For all applicants employees or eligible family members 39. Rheumatologic disorder 22. Anemia 1. Frequent/severe headaches or migraines 23. Blood transfusion 2. History of positive TB skin test IGRA or tuberculosis 11. Aneurysm blood...
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