Classification (check all boxes that apply) lists Class A Conditions and Class B Conditions (See Worksheets DS-3025, DS-3026, DS-3030).
Date Exam Expires: 3 months if Class B0 or B1 TB, otherwise 6 months.
Applicant Category: mark one.
Vaccination Documentation: see DS-3025, mark one.
Physician: attests that the medical classification is correct in accordance with the Centers for Disease Control and Prevention's Technical Instructions.
Not supplying it: individuals who fail to submit this form or who do not provide all the requested information may be denied a U.S. visa or experience processing delays.
| Question | Answer |
|---|---|
| Form Name | Form DS-2054 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 87 |
| Avg. time to fill out | 15 min |
| Edition | 03-2020 |
| Issuing agency | U.S. Department of State |
| Other names | DS-2054, DS2054, DS 2054, Form 2054, Report of Medical Examination |
| Official source | Form DS-2054 (Rev 03-2020), U.S. Department of State |
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