attachment_c.docx

United States Department of State

Washington, DC 20520

TO: Medical Examiner

Examinee Name: ______________________________

Employer Name: ______________________________

· Note: Medical resources in Iraq and Afghanistan are extremely limited. Individuals with medical conditions requiring follow-up or supervision are not medically qualified to serve in these countries.

This is to certify that I have examined the above-mentioned patient and have determined that he/she has no medical or psychiatric conditions that require medical supervision, routine follow-up or access to emergency or specialized care.

I also certify that the examinee has no contraindications to performing vigorous activities and heavy lifting.

Note on Physical Exertion - When transiting in and out of Baghdad Airport, all are REQUIRED to wear body armor (vest and helmet), weighing approximately 30 pounds. In addition, all are required to carry one’s own luggage (no porters are available) over dirt and gravel roads. This process can be extremely physically exerting if the luggage is two full suitcases (30-40 pounds each). Transportation in and out of the International Zone (Embassy) is either by helicopter or Rhino bus. Helicopter transport requires wearing the helmet and body armor as well as jumping in and out of the back of the helicopter. The height required to jump may be as high as waist level. The luggage must be lifted into the helicopter as well. Many injuries have occurred to persons who were not physically capable of performing these activities.

Signature: __________________________________

Date of Examination: ____________________________

Address: __________________________________

Phone Number: __________________________________

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