Immigration Medical Exams


IMMIGRATION MEDICAL EXAM

Civil Surgeon

Dr Phanor calle is a medically trained, licensed and experienced doctor practicing in the U.S. who is certified by USCIS (U.S. Citizenship and Immigration Service). He received U.S. immigration-focused training in order to provide examinations as required by the CDC (Center for Disease Control and Prevention) and USCIS.

IMPORTANT: medical examinations will not be recognized if they are given by a doctor in the U.S. who is not a Civil Surgeon; please make sure that your appointment is with a Civil Surgeon or your results and documents will be invalid.

I-693, Report of Medical Examination and Vaccination Record

http://www.uscis.gov/sites/default/files/files/form/i-693.pdf

http://www.uscis.gov/sites/default/files/files/form/i-693instr.pdf

Purpose of Form

Generally, all applicants filing for adjustment of status to that of a lawful permanent resident must submit Form I-693 completed by a designated civil surgeon. Form I-693 is used to report results of a medical examination to USCIS. The examination is required to establish that an applicant is not inadmissible to the United States on public health grounds.

Where to File

After completion of the medical examination, the civil surgeon is required to give you, the applicant, the completed Form I-693 in a sealed envelope. Do not accept it if it is not in a sealed envelope. USCIS will return the form to you if it is not in a sealed envelope or if the envelope has been opened or altered.

It is the applicant’s responsibility to submit the Form I-693 to USCIS, not the civil surgeon’s.

If you are applying for adjustment of status: Submit Form I-693 with your Form I-485, Application to Register for Permanent Residence or Adjust Status, as detailed in the Form I-485 instructions.

Other applicants: Follow the instructions on or included with the application or the instructions given to you by the office requesting the medical examination.

Filing Fee

Note that USCIS does not regulate fees charged by civil surgeons for medical examinations.

Especial Intructions

Vaccination Requirements

Under the immigration laws of the United States, a foreign national who applies for an immigrant visa abroad, or who seeks to adjust status to a permanent resident while in the United States, is required to receive vaccinations to prevent the following diseases:

  • Mumps
  • Measles
  • Rubella
  • Polio
  • Tetanus and Diphtheria Toxoids
  • Pertussis
  • Haemophilus influenzae type B
  • Hepatitis B
  • Any other vaccine-preventable diseases recommended by the Advisory Committee for Immunization Practices

How do I know which vaccines are required for immigration purposes?

A civil surgeon is required to follow the Technical Instructions for the Examination of Aliens in the United States, including the 2009 Technical Instructions to Civil Surgeons for Vaccinations, and any updates published online. CDC publishes the vaccination requirements and medical examination instructions (including a detailed table listing all required vaccines) at http://www.cdc.gov/immigrantrefugeehealth/exams/ti/civil/vaccination-civil-technical-instructions.html

Do I have to receive all the vaccines on CDC’s vaccination list for the immigrant population, or only the ones that are age appropriate?

You are required to document receipt of vaccines that are age appropriate for you. The civil surgeon will annotate Form I-693 to indicate that you were not required to receive a particular vaccine because it was not age appropriate at the time of the medical examination.

Do I have to receive all the vaccines that are on CDC’s list and that are age appropriate, although I may have a medical condition that prevents me from receiving the required vaccines?

If you have a medical condition that prevents you from receiving a vaccine that is appropriate for your age, the civil surgeon will annotate the Form I-693 accordingly and mark the vaccine as contraindicated. A contraindication is a condition that prevents you from receiving a particular vaccine. CDC lists in its Technical Instructions what is considered a contraindication. It is up to the civil surgeon to determine whether you have such a condition that prevents you from receiving a particular vaccine at the time of the immigration medical examination.

Frequent questions about form I-693, Vaccines, and Tuberculosis.

Certain vaccine series can only be completed with multiple visits to the civil surgeon. Am I required to complete the entire series before the civil surgeon can sign the Form I-693?

You are only required to receive a single dose of each vaccine when you visit the civil surgeon. You are encouraged to follow up with your private health care provider to complete the series. Once you have received the single dose appropriate at the time, the civil surgeon can sign and certify the Form I-693.

I am pregnant and do not wish to receive any vaccinations. Do I still have to get them to be able to obtain permanent resident status in the United States?

If you are pregnant, the CDC’s Technical Instructions direct the civil surgeon how to evaluate the vaccines you are able to receive during pregnancy. If the civil surgeon cannot safely administer a required vaccine, he/she will annotate the Form I-693 by marking the vaccine as contraindicated. See link to the right for information on pregnancy and vaccinations in general.

Can the civil surgeon safely administer all vaccines that are required all at once?

The civil surgeon will let you know if you can receive all the vaccines at once, or if there is a concern based on your particular medical condition that will not allow you to receive all required vaccines at once.

When does the flu season start for purposes of the seasonal flu vaccine requirement? Since the seasonal flu vaccine is required, do I have to get the seasonal flu vaccine if it is not the flu season?

For purposes of the immigration medical examination, the flu season starts on October 1 and ends on March 31 each year. If your immigration medical examination is during this period, you are required to have the seasonal flu vaccine. If you have an immigration medical examination completed between April 1 and September 30, when it is not the flu season for immigration purposes, you are not required to document that you have received the seasonal flu vaccine.

Can I be forced to be vaccinated for immigration purposes?

If you refuse to receive the vaccines required for immigration purposes, as mandated by the immigration laws of the United States, your application for legal permanent resident status may be denied

What will happen if I refuse to receive one or all of the required vaccines?

Tell the civil surgeon if you do not wish to receive the required vaccines or a particular vaccine. You should also tell the civil surgeon the reason you do not wish to receive the vaccine(s). In this case, a waiver may be available to you, but only under the following circumstances:

  • You are opposed to vaccinations in any form– that is, you cannot obtain a waiver based on an objection only as to one vaccination
  • Your objection must be based on religious beliefs or moral convictions; and
  • The religious or moral beliefs must be sincere.

The form used to apply for a waiver depends on the adjustment category under which you are seeking legal permanent residence status. For example, refugees and asylees seeking adjustment of status should file Form I-602, Application by Refugee for Waiver of Grounds of Excludability. Individuals seeking adjustment of status as a result of an approved Form I-130, Petition for Alien Relative, or Form I-140, Immigrant Petition for Alien Worker, would file Form I-601, Application for Waiver of Grounds of Inadmissibility.

Will USCIS accept a Form I-693 if the vaccination chart is incomplete?

No. The vaccination chart should have at least one entry in each row for each vaccine. If the vaccination chart is not properly completed at the time of the medical examination, USCIS may return the Form I-693 to you with instructions on how to correct it.

Who pays for the vaccinations?

The applicant is responsible for paying the appropriate fee for all vaccinations directly to the civil surgeon, as agreed upon with the civil surgeon. You should ask about the price of the vaccinations before the medical examination or the administration of the vaccinations.

Tuberculosis Questions?

What is Tuberculosis?

Tuberculosis (TB) is a disease caused by bacteria called Myobacterium tuberculosis. The bacteria usually attack the lungs. But TB bacteria can attack any part of the body, such as the kidney, spine, and brain. If not treated properly, TB disease can be fatal. TB disease was once the leading cause of death in the United States.

TB is spread through the air from one person to another. The bacteria are put into the air when a person with active TB disease of the lungs or throat coughs, sneezes, speaks, or sings. People nearby may breathe in these bacteria and become infected.

However, not everyone infected with TB bacteria becomes sick. People who are infected but not sick have what is called latent TB infection. People who have latent TB infection do not feel sick, do not have any symptoms, and cannot spread TB to others. However, some people with latent TB infection go on to get TB disease. People with active TB disease can be treated if they seek medical help. Most people with latent TB infection can take medicine so that they will not develop active TB disease. For more information on TB infection, visit www.cdc.gov.

Why am I, as an applicant for adjustment of status, screened for TB?    

Every immigrant, including an adjustment of status applicant, has to be screened for health-related grounds of inadmissibility, such as communicable diseases of public health significance. Adjustment of status applicants are screened by going to a civil surgeon (a physician that is designated by USCIS) and having a medical examination which includes a screening for communicable diseases of public health significance (such as TB) and other physical or mental conditions. The civil surgeon also assesses vaccination status and administers required vaccines. If the civil surgeon encounters an individual with a significant health-related condition, the civil surgeon will be able, for most conditions, to prescribe the necessary treatment so that the inadmissibility no longer exists and the danger to the public is eliminated or diminished.

What is a tuberculin skin test (TST)?

The tuberculin skin test (TST) is the administration of a tuberculin solution in between the different levels of your skin. The Technical Instructions require a Mantoux tuberculin skin test, which is an intradermal injection of the tuberculin solution. After the administration of the test by the civil surgeon’s staff, you will need to return to the civil surgeon’s office within 48 to 72 hours to have the result read. Generally, if the reaction is 4 mm or less, you will not need any further tests for TB. If the reaction is 5mm or greater, you are required to have a chest x-ray as a means of additional screening for TB.

There are certain exceptions that do not require you to undergo another TST if you had one previously. If possible, you should bring written documentation of any previous TB screening to your appointment with the civil surgeon so that the civil surgeon is able to determine whether you are required to have another one.

What is initial testing with interferon gamma release assay (in place of TST)?

To fulfill the requirement of the initial TB testing, civil surgeons may, as of November 1, 2009, use interferon gamma release assay (IGRA), which are blood tests. The IGRAs that are currently acceptable to CDC are: the QuantiFERON ® TB Gold Test, the QuantiFERON® TB Gold in Tube Test, and the T-Spot ® TB Test. CDC may add additional tests. If it does, it will publish the inclusion of any test on its website at http://www.cdc.gov/ncidod/dq/civil.htm.

If you choose an IGRA (in place of a TST), the civil surgeon will take a blood sample from you during the medical examination. The blood is used to perform the TB initial screening test. Unlike with the TST, you will not have to return to the civil surgeon’s office to have the test result read.

The results of the IGRA test are generally available within 24 hours of your office visit. If the result is negative, you will probably not need any further testing for TB. If the result is positive, you will be required to have a chest x-ray as a means of additional screening for TB. You may not have a TST or other initial screening test; the administration of more than one initial screening test is a violation of the Technical Instructions.

There are certain exceptions to the IGRA testing requirement. For the civil surgeon to make the best determination of what is required, you should bring, at the time of your appointment with the civil surgeon, written documentation of any IGRA testing you previously had

Do I need both the TST and an IGRA test?

No. Only one of the tests is required as an initial screening method to determine whether you are infected with TB. Also, only one initial screening method is allowed, according to the update to the TB Component, as published on CDC’s website at http://cdc.gov/ncidod/dq/civil.htm.

Can I choose a particular test?

In general, any of the initial testing methods permitted is suitable for use in most persons. The TST is widely available. The QuantiFERON-TB Gold Test, QuantiFERON® TB Gold in Tube Test and the T-Spot TB test are not currently as widely available in the United States as the TST. If one or more of the tests would not be suitable for you, or is not available, the civil surgeon will inform you and not perform that particular test. Otherwise, you may discuss the options with the civil surgeon.

Which initial testing method is better, the TST or the IGRA blood tests?

Each of these tests has been approved by the federal Food and Drug Administration (FDA) as suitable methods for initial testing for TB. While the TST may be inconvenient due to the need of a follow up visit, the IGRA tests have availability and cost limitations. Once the civil surgeon has informed you of your options, you can make a decision.

Does a civil surgeon have to offer all three tests to me?

No. The civil surgeon is only required to offer one initial testing method.

Who pays for the initial TB test?

As is the case with all the tests that are needed for the proper completion of the medical examination requirement, the applicant is responsible for paying the appropriate fee for the test. You will have to pay this fee directly to the civil surgeon, as agreed upon with the civil surgeon. Some of the initial TB tests are much more expensive than others. Prior to the administration of the test, you should ask about the price of the test.

About Dr Phanor Calle

is a medically trained, licensed and experienced doctor practicing in the U.S. who is certified by USCIS (U.S. Citizenship and Immigration Service). He received U.S. immigration-focused training in order to provide examinations as required by the CDC (Center for Disease Control and Prevention) and USCIS.

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