Medical History and Examination

Medical History and Examination

OMB: 1405-0068

IC ID: 14884

Documents and Forms

Document Name Document Type
Form DS-1622 Medical History and Examination Form and Instruction
DS-1622 Medical History and Examination for Children age 11 and younger DS-1622 12-15-2023.pdf Form and Instruction
DS-1843 Medical History and Examination for Children age 12 and older DS-1843 12-15-2023.pdf Form and Instruction