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U. S. Department of State OMB No. 14050113 EXPIRATION DATE: XX/XX/XXX ESTIMATED BURDEN: 10 minutes (See Page 2 Back of Form)REPORT OF MEDICAL EXAMINATION BY PANEL PHYSICIAN PhotoSurnamesGiven NamesBirth
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What is by panel physician?
Panel physician is a physician designated by the U.S. Department of State to conduct medical examinations of visa applicants.
Who is required to file by panel physician?
Visa applicants are required to file by panel physician before their visa interview.
How to fill out by panel physician?
Applicants must schedule an appointment with an approved panel physician and bring all required documents and information for the examination.
What is the purpose of by panel physician?
The purpose of the panel physician examination is to ensure that visa applicants are not inadmissible to the United States based on health grounds.
What information must be reported on by panel physician?
The panel physician must report on the applicant's medical history, examination results, and any required vaccinations.
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