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Yes! You can use AI to fill out Form DS-1843, Medical History and Examination for Individuals Age 12 and Older

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Form DS-1843, Medical History and Examination for Individuals Age 12 and Older, page 1
Complex · 77/100Form Complexity Index

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What this form asks for

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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.
Fillable fields304
Pages5
Sections109
Tables and lists3
Form Complexity IndexComplex, 77/100

The AI checks your answers before you download

14 checks built for this form, so a wrong date or a missing answer is caught before anyone else sees it.

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.

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.

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.

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.

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.

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.

And 8 more checks
  • Conditional Requirement for Lipid Profile Attachment
  • Conditional Requirement for Chest X-Ray Attachment
  • Logical Check for Pregnancy Question
  • Verifies Completeness of Required Lab Report Attachments
  • Ensures Examinee Signature and Date are Present
  • Logical Check for Post Assignment Dates
  • Verifies Selection of Examinee Status
  • Verifies Selection of Agency or Company

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How to Fill Out DS-1843 Online for Free in 2026

What the AI walks you through.

  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.

Common Mistakes in Completing DS-1843

The ones the AI is built to catch.

Incomplete 'Yes' Answer Explanations
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.
Failure to Attach Required Lab Reports
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.
Incorrect Date Formatting
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.
Missing Information on Subsequent Pages
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.
Providing Prohibited Genetic Information
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.
Incomplete Medication and Allergy Lists
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.
Missing or Illegible Signatures
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.
Submitting Non-English or Unidentified Lab Reports
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.
Using Temporary or Soon-to-be-Obsolete Contact Information
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.
Incorrect Name Order
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.

Frequently Asked Questions About DS-1843

 

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Can I fill other forms too?
This plan is for your DS-1843: your own AI agent fills it as often as 5 times a month. To fill other forms and upload your own, choose a Professional plan from your account.
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From your account, in two clicks, any time. No email, no call.
How does the AI fill out DS-1843?
You answer a few questions in plain words, or upload your current passport. The AI reads what you give it and puts each answer into the right field of DS-1843, on every page, in seconds. It checks the answers against the form's own rules, and you review and change anything before you download, print or sign.
What happens to my information?
It is encrypted in transit and at rest, and it is never used to train AI.
How complex is DS-1843 to fill out?
DS-1843 has a Form Complexity Index of 77 out of 100, in the complex tier: 304 fillable fields across 5 pages. Instafill.ai's AI fills it in under a minute, with every field there for you to review before you download.
What is the purpose of Form DS-1843, and who needs to complete it?
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.
What documents do I need to submit along with the DS-1843 form?
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.
How recent do my laboratory tests need to be?
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.
I answered 'Yes' to some questions in the Medical History section. What do I need to do?
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.
How do I submit the completed Form DS-1843 and my medical reports?
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.
What is the GINA notice on the first page about?
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.
Who needs to sign the form and where?
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.
Is a chest x-ray always required?
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.
Can I use an AI tool to help me fill out this form?
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.
How can I fill out the DS-1843 form online using Instafill.ai?
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.
What should I do if the DS-1843 PDF I have is not fillable?
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.
Why does the form ask for contact information valid for the next 90 days?
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.
Is providing my medical information on this form mandatory?
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.
What is the medical examiner's responsibility when completing this form?
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.
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