Last updated on Apr 10, 2026
DS-1622 free printable template
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What is DS-1622
The Foreign Service Medical History Form (DS-1622) is a government document used by the U.S. Department of State to determine medical eligibility for individuals entering the Foreign Service.
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DS-1622 is needed by:
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U.S. citizens applying for Foreign Service positions
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Parents or sponsors of children needing medical clearance
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Medical examiners conducting evaluations for the Foreign Service
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Applicants for Foreign Service medical clearance
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Individuals undergoing separation or new dependent examinations
Comprehensive Guide to DS-1622
What is the Foreign Service Medical History Form?
The Foreign Service Medical History Form, also known as the DS-1622 form, serves a crucial role in determining medical eligibility for individuals applying to the Foreign Service. This U.S. State Department form collects vital medical information, including a comprehensive medical history and examination results, from applicants. Providing accurate and complete information is essential, as it directly impacts the assessment process for achieving foreign service medical clearance.
Purpose and Benefits of the Foreign Service Medical History Form
The primary objective of the Foreign Service Medical History Form is to ensure that applicants meet the necessary health standards for service abroad. Completing this medical history form offers multiple benefits, including:
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Facilitating the medical evaluation process for foreign service opportunities.
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Assisting in determining appropriate assignments abroad based on medical eligibility.
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Ensuring comprehensive medical history documentation, particularly for children.
Who Needs to Complete the Foreign Service Medical History Form?
The target audience for the Foreign Service Medical History Form includes sponsors, parents, and examiners. It specifically encompasses individuals completing the form on behalf of children aged 11 years and under. The form is required in various situations, including:
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Pre-employment examinations for prospective foreign service employees.
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In-service evaluations for current employees or their dependents.
Key Features of the Foreign Service Medical History Form
This form consists of several key components designed for usability and clarity. Notable features include:
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Personal information fields, such as "NAME OF EXAMINEE (Last, First, Middle)"
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Check boxes for symptoms and medical conditions, improving the form's clarity.
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Instructions for both sponsors and examiners to streamline the completion process.
Additionally, proper signatures are essential for validating the form before submission.
How to Fill Out the Foreign Service Medical History Form Online (Step-by-Step)
Completing the Foreign Service Medical History Form online via pdfFiller simplifies the process. Follow these steps to fill out the form:
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Open the form using pdfFiller.
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Input the required personal information in fields like "NAME OF EXAMINEE."
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Carefully select appropriate checkboxes for medical history items.
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Review each section, ensuring all details are accurate.
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Complete the signature lines for both the sponsor and the examiner.
Utilizing an online format may enhance precision and efficiency in filling out this form.
Common Errors and How to Avoid Them When Filling Out the Form
Individuals often make several common mistakes when completing the DS-1622 form. Awareness of these errors can facilitate correct submission. Some typical mistakes include:
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Incomplete sections, leading to delays in processing.
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Illegible handwriting that makes the information difficult to read.
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Failure to sign the form where required, resulting in rejection.
To mitigate these issues, consider using a validation checklist to review the form prior to submission, ensuring all necessary details are correctly entered.
How to Sign and Submit the Foreign Service Medical History Form
Understanding the different signing methods for the Foreign Service Medical History Form is crucial. The process can include:
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eSigning, which offers a convenient alternative to traditional wet signatures.
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Submission methods, including online and by mail.
It is essential to choose the appropriate delivery options and clarify where to submit the completed form for processing.
What Happens After You Submit the Foreign Service Medical History Form?
Once the Foreign Service Medical History Form has been submitted, applicants can expect a specific processing timeline. Typically, the next steps may include:
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Receiving notification of application status updates through tracking options.
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Awareness of common rejection reasons, such as incomplete information or invalid signatures.
Reviewing these criteria can significantly streamline the process for applicants.
Security and Compliance for Sensitive Information in the Foreign Service Medical History Form
The protection of sensitive personal data is crucial when handling the Foreign Service Medical History Form. pdfFiller employs rigorous security measures, including:
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256-bit encryption for data protection.
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Compliance with regulations such as HIPAA and GDPR.
These measures help reassure users regarding the privacy and safety of their information when filling out the DS-1622 form.
Empower Your Submission of the Foreign Service Medical History Form with pdfFiller
Utilizing pdfFiller can enhance your experience in submitting the Foreign Service Medical History Form. Key features of the platform include:
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Easy editing and filling capabilities.
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Convenient eSigning options that expedite the process.
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Secure sharing functionalities to protect sensitive medical information.
Choosing pdfFiller not only simplifies the form-filling process, but also ensures secure handling of all medical documentation.
How to fill out the DS-1622
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1.To start, visit pdfFiller and log into your account or create a new one if you haven’t already.
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2.Once logged in, use the search function to locate the Foreign Service Medical History Form, DS-1622.
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3.Begin filling out the form by entering your information in the required fields. Make sure to provide accurate details about the examinee's medical history.
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4.Before you fill in the form, gather all necessary medical information, including previous medical records and examination results.
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5.Navigate through the form, using checkboxes for yes/no questions, and be sure to enter personal information where prompted.
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6.Follow the specific instructions on the form, such as filling out fields labeled 'Name of Examinee' and 'Signature of Sponsor or Parent.'
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7.Once all fields are completed, review the form for accuracy, ensuring that all necessary sections are filled out correctly.
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8.If any information is missing, return to the corresponding fields to ensure everything is complete before finalizing.
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9.After confirming that your form is complete, save your progress in pdfFiller.
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10.Download the completed form or submit it directly through pdfFiller as per the instructions provided.
Who is required to fill out the Foreign Service Medical History Form?
The form must be filled out by individuals applying for positions in the Foreign Service, their sponsors or parents, and medical examiners conducting evaluations for applicants under 11 years.
What supporting documents do I need to complete this form?
You will need to gather previous medical records, examination results, and personal identification for the examinee before starting to fill out the Foreign Service Medical History Form.
How do I submit the Foreign Service Medical History Form?
The completed form can be submitted directly through pdfFiller after saving it, or you may download and print it for manual submission as required by the U.S. Department of State.
Are there any deadlines for submitting this form?
Yes, it is recommended to submit the Foreign Service Medical History Form as soon as possible to avoid delays in the Foreign Service application process. Check the specific guidelines provided by the U.S. Department of State.
What common mistakes should I avoid while completing this form?
Common mistakes include leaving fields blank, providing incorrect medical history, or failing to obtain required signatures from the sponsor or examiner. Double-check all entries before submission.
How long will it take to process the Foreign Service Medical History Form?
Processing times for the Foreign Service Medical History Form can vary. It may take several weeks, so ensure submission well in advance of any related deadlines.
Can I make changes to the form after submitting it?
Once the Foreign Service Medical History Form is submitted, corrections may require new submissions. It's advised to review the form thoroughly before submission to minimize this need.
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