Yes! You can use AI to fill out Form DS-1843, Medical History and Examination for Individuals Age 12 and Older
Form DS-1843, Medical History and Examination for Individuals Age 12 and Older, is a comprehensive document used by the U.S. Department of State to evaluate the health of employees, applicants, and their family members for overseas posts. It gathers detailed demographic data, a thorough medical history, and results from a clinical examination to determine medical clearance. Today, this form can be filled out quickly and accurately using AI-powered services like Instafill.ai, which can also convert non-fillable PDF versions into interactive fillable forms.
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Form specifications
| Form name: | Form DS-1843, Medical History and Examination for Individuals Age 12 and Older |
| Number of pages: | 5 |
| Language: | English |
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How to Fill Out DS-1843 Online for Free in 2026
Are you looking to fill out a DS-1843 form online quickly and accurately? Instafill.ai offers the #1 AI-powered PDF filling software of 2026, allowing you to complete your DS-1843 form in just 37 seconds or less.
Follow these steps to fill out your DS-1843 form online using Instafill.ai:
- 1 Navigate to Instafill.ai and upload or select Form DS-1843.
- 2 Complete the demographic information in Section I, including name, date of birth, contact details, and assignment information.
- 3 Fill out the detailed medical history questionnaire in Section II, answering all questions and providing written explanations for any 'Yes' answers.
- 4 List all current medications, drug allergies, and past hospitalizations or operations in Sections III and IV.
- 5 Have a qualified medical examiner complete the clinical evaluation (Sections VII-IX) and record all required laboratory analysis results in Section X, ensuring all lab reports are attached.
- 6 Review the entire form for accuracy, then the examinee (or parent) must sign and date Section V, and the medical examiner must sign and date the final page.
- 7 Submit the completed, signed form along with all required attachments as a single PDF file via email or fax as instructed on the form.
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Frequently Asked Questions About Form DS-1843
Form DS-1843 is a Medical History and Examination form used by the U.S. Department of State to make medical clearance decisions for individuals assigned abroad. It must be completed by employees, applicants, and their eligible family members who are age 12 and older.
You must submit copies of all required laboratory test results, including hematology, chemistry, and serology reports. If applicable for your age or condition, you also need to include an ECG tracing and a chest x-ray report.
Your lab test results are acceptable if they were performed within the last 12 months. All attached lab reports must be in English and clearly identify you with your full name and date of birth.
For every 'Yes' answer in the Medical History section (Section II), you must provide a written explanation in Section IIA. Be sure to include the date of occurrence for each condition or event you are explaining.
Submit the completed form and all supporting documents as a PDF via email to [email protected]. Do not send them by U.S. Mail or courier services like FedEx or DHL; faxing to 202-647-0292 is an alternative option.
The Genetic Information Nondiscrimination Act (GINA) notice informs you not to provide any genetic information, including your family's medical history. This is to ensure compliance with federal law prohibiting employers from requesting or using such information.
The examinee (or their parent if under 18) must sign and date Section V on page 3 to certify the information is accurate. The medical examiner who performs the physical evaluation must sign and provide their details on page 5.
No, a chest x-ray is only required if your Tuberculin Skin Test (TST) is positive (over 10mm), you have a positive IGRA blood test, or if it is otherwise clinically indicated by your physician.
Yes, services like Instafill.ai use AI to help complete this form. These tools can accurately auto-fill your personal information into the correct fields, which saves time and helps reduce errors.
Simply upload the DS-1843 PDF to the Instafill.ai platform. The AI will identify the form fields, allowing you to type your information directly into the digital form before downloading or printing it.
If you have a non-fillable or 'flat' PDF, you can upload it to a service like Instafill.ai. The tool will automatically convert it into an interactive, fillable form that you can complete on your computer.
The form requests a reliable email and phone number for the next 90 days so that the Bureau of Medical Services can easily reach you if they have questions or need additional information to process your medical clearance.
According to the Privacy Act Notice, providing this information is voluntary. However, failing to provide the requested information may result in your inability to obtain the required medical clearance for your overseas assignment.
The medical examiner must perform the clinical evaluation, comment on any positive medical history or abnormal findings, and provide recommendations for any necessary follow-up or treatment. They must also sign the form to validate the examination.
Compliance DS-1843
Validation Checks by Instafill.ai
1
Verifies Age is 12 or Older
This check calculates the examinee's age using the 'Date of Birth' and the 'Date of Exam'. It then verifies that the calculated age is 12 years or older, as specified by the form title 'FOR INDIVIDUALS AGE 12 AND OLDER'. This is crucial for ensuring the correct form is used for the examinee's age group. If the age is less than 12, the submission should be blocked and the user directed to the appropriate form for younger individuals.
2
Ensures Date of Exam is After Date of Birth
This is a logical consistency check that validates the 'Date of Exam' (page 1) occurs after the 'Date of Birth of Examinee' (Field 3). This prevents nonsensical data entry, such as an examination date that precedes the person's birth. If this validation fails, it indicates a data entry error that must be corrected before the form can be processed.
3
Requires Explanation for 'Yes' Answers in Medical History
This validation ensures that for every 'Yes' answer to questions 1-36 in Section II (Medical History), the corresponding 'Explanations' field (Section IIA) is not empty. This is critical for the medical clearance process, as a simple 'Yes' without context is insufficient for evaluation. A failure would prompt the user to provide a detailed explanation for each affirmative answer before submission.
4
Validates Primary Email Address Format
This check ensures that the value entered in the 'Primary E-mail Address' field (Field 11) conforms to a standard email format (e.g., [email protected]). This is important for ensuring the agency can reliably contact the examinee for follow-up information or to communicate the results of the medical clearance. An invalid format would trigger an error message requiring the user to correct the entry.
5
Validates Primary Telephone Number Format
This check verifies that the 'Primary Telephone Number' (Field 12) is entered in a valid and recognizable format, including country code and area code. Proper formatting is essential for communication, especially for international assignments. If the number does not match expected patterns, the system should prompt the user to correct it to ensure contact can be made.
6
Conditional Requirement for ECG Attachment
This check is triggered based on the examinee's age. If the calculated age is 50 years or older, the system verifies that an ECG tracing file has been attached as required by Section X, item 4. This ensures compliance with age-based screening protocols. If the examinee is 50+ and the file is missing, the submission is flagged as incomplete.
7
Conditional Requirement for Lipid Profile Attachment
This validation checks the examinee's age and enforces a conditional rule from Section X, item 1D. If the examinee is over 50 years of age, the system must confirm that a lab report for the Lipid Profile has been attached. This is vital for assessing cardiovascular risk in the specified age group. A missing report for an eligible individual would prevent a complete medical review.
8
Conditional Requirement for Chest X-Ray Attachment
This check enforces the rule in Section X, item 3, which makes a Chest X-Ray conditional. The system will verify if the Tuberculin Skin Test (TST) result is greater than 10mm or if the IGRA test result is positive. If either of these conditions is met, this validation ensures that a Chest X-Ray report has been attached. Failure to attach the required report would render the tuberculosis screening incomplete.
9
Logical Check for Pregnancy Question
This validation ensures that question 21, 'Are you pregnant?', can only be answered if the examinee's 'Sex' (Field 5) is selected as 'Female'. This prevents logical impossibilities in the data and improves the user experience by hiding or disabling irrelevant questions. If an attempt is made to answer this question for a male examinee, the system should reject the input.
10
Verifies Completeness of Required Lab Report Attachments
As stated in Section X, several lab reports are required and must be attached. This check verifies the presence of attached files corresponding to Hematology, Chemistry, and Serology reports. Since these tests are fundamental to the medical clearance, their absence would make the submission incomplete. The system should prevent submission until these mandatory files are uploaded.
11
Ensures Examinee Signature and Date are Present
This validation confirms that the 'Signature of Examinee or Parent' and the accompanying 'Date' field in Section V are not empty. The signature certifies that the information provided is true and that the Privacy Act Notice has been read. An unsigned form is legally and administratively incomplete and cannot be processed.
12
Logical Check for Post Assignment Dates
This check validates the dates entered in Field 14, 'Post of Assignment'. It ensures that the 'Estimated Date of Arrival' (EDA) at the proposed post is chronologically after the 'Estimated Date of Departure' (EDD) from the present post. This prevents logical errors in the assignment timeline and ensures the data accurately reflects the examinee's travel schedule. An error would require the user to review and correct the dates.
13
Verifies Selection of Examinee Status
This is a completeness check for Field 6, 'Status'. The system must ensure that at least one checkbox (e.g., 'Employee', 'Applicant', 'Spouse', 'Dependent Child') is selected. This information is fundamental for determining eligibility and the context of the examination. The form cannot be properly routed or evaluated without a defined status for the examinee.
14
Verifies Selection of Agency or Company
This validation ensures that at least one option is selected in Field 7, 'Agency of Employee/Applicant/Sponsor'. This information is critical for administrative purposes, routing, and determining which specific regulations or policies apply to the examinee. A submission without this information would be considered incomplete and would require clarification.
Common Mistakes in Completing DS-1843
Examinees frequently check 'Yes' to a medical history question in Section II but fail to provide the mandatory written explanation and date of occurrence in Section IIA. This oversight often happens when rushing and leads to an incomplete application. The form will be rejected and returned for correction, causing significant delays in the medical clearance process. Always double-check that every 'Yes' answer is fully explained as instructed.
A very common error is submitting the DS-1843 form without attaching copies of all required laboratory reports as specified in Section X. People may assume the doctor's summary is sufficient or forget to gather the documents before submission. This immediately renders the application incomplete, halting the review process until the missing reports are provided. Ensure all required lab reports are attached in PDF format with the form.
The form explicitly requires the 'mm-dd-yyyy' format for all dates, but applicants often use their local convention, such as 'dd-mm-yyyy', or write it out. This inconsistency can cause data entry errors and processing delays. Using an AI-powered form filler like Instafill.ai can help prevent this by automatically formatting dates correctly as you enter them, ensuring compliance with the form's requirements.
The form requires the examinee's name and date of birth at the top of pages 2, 3, 4, and 5, but people often only fill it out on the first page. If the pages are separated during processing, they become unidentifiable, which can lead to lost information or rejection of the entire submission. To prevent this, meticulously fill out the header on every single page of the document.
Despite a prominent GINA warning on page 1, individuals sometimes include family medical history in their explanations (e.g., 'My father had high blood pressure'). This is done instinctively when describing a condition but is a direct violation of the stated instructions. Providing this information can create legal and processing complications. Focus only on your personal medical history when filling out the form.
In Section III, applicants often list only their prescription medications, forgetting to include over-the-counter drugs, vitamins, herbs, and supplements as explicitly requested. This provides an incomplete picture of the examinee's health regimen. A complete list is crucial for a thorough medical evaluation, so be sure to list everything you take regularly, not just prescriptions.
Submitting the form without the examinee's signature and date in Section V is a critical error that invalidates the certification of the information provided. Similarly, failing to ensure the medical examiner has signed and dated page 5 will also result in rejection. Always review the form for all required signatures before submission. If the form is a non-fillable PDF, a tool like Instafill.ai can convert it to a fillable version, allowing for clean digital signatures.
The instructions clearly state that all attached lab reports must be in English and identified with the examinee's full name and date of birth. Submitting reports in another language without a certified translation or without clear patient identifiers will cause the application to be rejected. This happens frequently with exams performed outside the U.S. Always verify that all supporting documents meet these specific requirements before submission.
Fields 11 and 12 ask for an email and phone number where you can be reached for the next 90 days, which is a critical period for follow-up questions. Applicants sometimes provide their current contact details, which may become invalid after they move. This can make it impossible for the medical office to contact you, delaying clearance. Provide stable, long-term contact information or a reliable alternate contact.
Field 1a specifies the name format as 'Last, First, MI', but it is common for people to default to the more standard 'First, Last' order. This seemingly small mistake can cause mismatches in database records and slow down the administrative processing of the form. Carefully follow the specified format to ensure your file is created correctly from the start. AI form-filling tools can help by parsing your name and placing it in the correct fields automatically.
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