Get Dos Ds-3057 2020-2025

The DOS DS-3057 form is a crucial document for obtaining medical clearance for individuals participating in the Department of State's Medical Program while assigned abroad. This guide provides clear instructions on how to properly complete the form online, ensuring accurate and efficient submission.

Follow the steps to fill out the DOS DS-3057 online effectively.

1. Click ‘Get Form’ button to retrieve the DOS DS-3057 and open it in your editor of choice.
2. Begin by providing the patient's name in the appropriate field. This should include the last name, first name, and middle initial.
3. If the patient is a family member, indicate the name of the employee in the specified section.
4. Enter the MED ID number, if available. This helps in identifying the individual's medical records.
5. Fill in the date of birth format as mm-dd-yyyy.
6. Select the sex of the patient by indicating 'Female' or 'Male.'
7. Provide the place of birth, detailing the state, city, and country.
8. Identify the status of the individual by selecting one of the options: Employee, Spouse, or Dependent Child.
9. List the name of your health insurance plan.
10. Provide the telephone number where you can be reached for the next 90 days, including both primary and alternate numbers.
11. Enter your email address for contact purposes over the next 90 days.
12. Specify the agency you are affiliated with, such as State, USAID, or another agency.
13. If applicable, indicate the type of employment, choosing from options such as Foreign Service or Civil Service.
14. Detail the post of assignment including both proposed and present posts.
15. Complete the medical history update section, addressing current medications and any changes in medical status since the last clearance.
16. Attach any necessary documentation or additional pages required for your medical history or treatment plans.
17. After completing all fields, remember to sign the document and date it.
18. Scan the completed form and email it to the designated medical records address, ensuring all supplemental pages are included.
19. If electronic submission is not possible, fax the completed form to the medical records office.

Ready to submit your DOS DS-3057? Complete your documents online today!