Medical Examinations
(Vaccinations, Civil Surgeons, Panel Physicians,
Forms, Medical Waivers)

By: Allen E. Kaye

Common questions about medical examinations

Why are medical exams needed?

Medical examinations verify good health and admissibility to the United States on medical grounds. The exam can identify medical conditions that require follow-up medical care after emigration to the U.S. or adjustment of status to permanent residence.

All medical examinations include:

• Physical Examination: applicants are required to have a physical examination (to include complete disrobing), and a mental status evaluation.
  
  
• Tuberculin (TB) Skin Test: All applicants 2 years of age and older are required to have a tuberculin skin test (TST).
  
  
• Serologic (Blood) Test: All applicants 15 years of age and older are required to have serologic (blood) tests for HIV and for syphilis. Applicants under age 15 can be tested for HIV or syphilis if there is reason to suspect the possibility of infection. Civil Surgeons and Panel Physicians are required to provide pre-test counseling to all applicants who take the HIV test. If you are found to have HIV infection, the Civil Surgeon must provide you with post-test counseling.
  
  
• Vaccinations: Most applicants need to show that they are current with all vaccinations recommended by US public health officials. See our complete list of recommended vaccinations.

Who has to have a medical exam?

• Adjustment of Status applicants and immigrant visa applicants. Anyone applying for adjustment of status in the United States, or for an immigrant visa at a U.S. Consular post abroad, must undergo a medical exam including a vaccination assessment. Note: If the individual is applying for registry based on his or her entry before January 1, 1972, and has been in continuous residence in the United States since that date, a medical exam is not required.
  
  
• K and V nonimmigrant (temporary) visa applicants. Individuals applying for a K nonimmigrant visa as the fiancee or the spouse of a U.S. citizen or for a V nonimmigrant visa as the spouse or child of a lawful permanent resident (LPR) (including those applying for V status in the United States) must undergo a medical exam, but are not required to comply with the vaccination requirements at that time. They will be required to comply with the vaccination requirements when they eventually apply for adjustment of status.
  
  
• Refugees. Individuals outside of the United States applying for admission as refugees must undergo a medical exam, but they are not required to comply with the vaccination requirements at that time.
  
  
• Refugee adjustment applicants. Refugees become eligible to apply for adjustment of status 1 year after their initial refugee admission. When they apply for adjustment of status, they will not be required to repeat the medical exam they had overseas, unless a medical ground of inadmissibility was discovered. But, a refugee who is not required to repeat the medical exam must still comply with the vaccination requirements and submit the vaccination sign-off in support of the adjustment of status application. Contact your state refugee health coordinator or local refugee resettlement agency to find out whether it is possible for you to have the vaccination sign-off done by a state or local health department.
  
  
• Asylees. Individuals already in the United States who are applying for asylum are not required to have a medical exam.
  
  
• Asylee adjustment applicants. Individuals granted asylum become eligible to apply for adjustment of status 1 year after the date of approval. When they apply for adjustment of status, they are required to undergo the entire medical exam, including the vaccination assessment.
  
  Note: A medical exam is not required for other nonimmigrant visa applicants and nonimmigrants arriving at a port of entry, but the Consular officer overseas or the inspector at the port of entry has can require you to undergo an exam if there are reasons to believe that you might be inadmissible on medical grounds.

What if I am pregnant?

If you are pregnant, you are required to have a medical exam, but some parts of it may be postponed until after delivery of your baby, depending on the circumstances of your case. If you have any concerns, you should discuss them with your family doctor before the medical exam, with the Civil Surgeon, or with the Panel Physician.

What are the vaccination requirements?

You should have vaccinations for:

• Mumps
• Measles
• Rubella
• Polio
• Tetanus
• Diphtheria toxoids
• Pertussis
• Influenza type B
• Hepatitis B

If you are unable to submit all your vaccination records at the time of the exam, or if you have never had certain vaccines, the Civil Surgeon or Panel Physician can administer them to you. Important: Do not try to fulfill your vaccination requirements before you meet with the Panel Physician or Civil Surgeon, in case it is not medically appropriate for you to have one or more of the required vaccines.

What if vaccinations are contrary to my religious beliefs or moral convictions?

If you have firmly held religious or moral beliefs that do not permit vaccinations, you may still be eligible for adjustment of status. You will need to apply for a waiver of vaccination requirements.

What happens after the medical exam?

After the medical exam is complete, the Panel Physician (if you are abroad) or the Civil Surgeon (if you are in the United States) will certify the results on the appropriate forms and place them in a sealed envelope. DO NOT OPEN THE SEALED ENVELOPE. Turn in your envelope with your immigration application.

Who gives the medical exam?

Medical examinations are given by licensed and experienced doctors, called Civil Surgeons (in the U.S.A.) and Panel Physicians (outside of the U.S.A.). Doctors who qualify as Civil Surgeons or Panel Physicians receive special and on-going immigration oriented medical training and policy updates. Note: A medical exam performed by a doctor NOT approved by USCIS will not be recognized.

How do I find a designated Civil Surgeon in my area of the United States?

Using a telephone, you can receive the names of USCIS-designated Civil Surgeons in your area by calling the USCIS National Customer Service Center at 1 (800) 375-5283. You will need to provide your zip code so that they can give you the Civil Surgeons nearest to you. Be sure to have a pen or pencil ready to write down the names and telephone numbers when you call. If you have online access to the world wide web, you can find a selection of qualified doctors on the CIS Civil Surgeons database. At your local USCIS office, a list of Civil Surgeons is also available. It will be sent to you when you receive your appointment for an adjustment of status interview.

How do I find a Panel Physician if I am applying from overseas?

You can get the names of recognized Panel Physicians by contacting the Consular Office of your closest Consulate or Embassy of the United States Consular Office.

Who pays for the medical exam?

You do. You are responsible for paying all doctor and laboratory fees associated with your medical examination.

What form is needed for the medical exam?

If you are applying for adjustment of status in the United States, Form I-693, Medical Examination of Aliens Seeking Adjustment of Status, is used to report the results of the medical exam to USCIS. If you are applying for a visa at a U.S. Consular post overseas, Form DS 2053 (Formerly Form OF 157) will be given to you. The Consular officer will supply this form and the accompanying supplements, and will give you the names and telephone numbers of Panel Physicians in your area. There is also a vaccination supplement which your Civil Surgeon or Panel Physician will provide. It is used to record the results of the vaccination assessment.

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Is anything else needed?

Yes. When you come to your medical examination appointment, you need to bring your passport, or other form of government issued photo identification, and any written documentation of your vaccination history. If you are applying for an immigrant visa from outside of the United States, you need to bring 3 current visa-sized photographs.

What happens after the medical exam?

After the medical exam is complete, the Panel Physician (if you are abroad) or the Civil Surgeon (if you are in the United States) will certify the results on the appropriate forms and place them in a sealed envelope. DO NOT OPEN THE SEALED ENVELOPE. Turn in the envelope with your immigration application.

What is a "medical waiver" and what does it do?

A medical waiver permits an immigration applicant to be allowed into, or remain in the United States despite having a health condition identified as medical grounds of inadmissibility. Terms and conditions can be applied to a medical waiver on a case by case basis. You are eligible for a waiver if:

• You are the spouse or unmarried son or daughter or the minor, unmarried adopted child of a U.S. citizen or LPR; or
  
  
• You have a son or daughter or lawfully adopted child who is a U.S. citizen or LPR; or
  
  
• You are eligible for classification as a self-petitioning spouse or child (including your derivative children) because of abuse.

What are "medical grounds of inadmissibility"?

"Medical grounds of inadmissibility" is a term used when an applicant has a health condition which is a public health concern to the United States. Under the U.S. immigration laws, the medical grounds of inadmissibility are divided into four categories:

• communicable disease of public health significance;
• lack of required vaccinations (for immigrant visa applicants only);
• physical or mental disorders with harmful behavior; and
• drug abuse/drug addiction.

Are all physical or mental disorders considered "medically-related grounds of ineligibility"?

No. The Civil Surgeon or Panel Physician must determine that there is no harmful behavior associated with the disorder in question. If you have a history of a physical or a mental disorder, there must be a harmful behavior that is likely to recur in order for it to make you ineligible. If your condition has no associated harmful behavior, then you can proceed with your application process.

What happens if I have a physical or mental disorder with associated harmful behavior?

If you have a physical or mental condition with associated harmful behavior, you may still be eligible for adjustment of status. You may apply for a waiver according to the terms and conditions established by USCIS, in consultation with the CDC. If you are applying for adjustment of status in the United States, you must file Form I-601, Application for Waiver of Grounds of Excludability, including fee payment, with the USCIS office considering your adjustment of status application. If you are applying for an immigrant visa at a U.S. Consular post abroad, you must submit your waiver application to the Consular post that is considering your immigrant visa application. The Consular post will send your waiver application to the overseas USCIS office in that jurisdiction for a decision. If you are applying for admission as a refugee, or for adjustment of status 1 year following your initial admission as a refugee or the grant of asylum, you may be granted a waiver for humanitarian reasons, to assure family unity, or when it is otherwise in the public interest. You must file Form I-602, Application by Refugee for Waiver of Ground of Excludability, but you are not required to pay a fee.

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What happens if the Civil Surgeon or Panel Physician finds a health problem during the medical exam?

If a health condition is diagnosed which makes you inadmissible, you may still be eligible for immigration after completing treatment for the condition. In some cases, you may still be eligible for immigration after applying for a waiver to overcome the medical ground of inadmissibility.

What is a communicable disease of public health significance?

A "communicable disease of public health significance" is defined in the HHS regulations that cover the required medical exam for immigration purposes and includes the following 9 infectious medical conditions:

• severe acute respiratory syndrome (SARS)
• tuberculosis (TB)
• leprosy
• human immunodeficiency virus (HIV/AIDS)
• syphilis (infectious state)
• chancroid (STD, similar to syphilis and herpes)
• gonorrhea
• granuloma inguinale (STD, donovanosis)
• lymphogranuloma (STD, chlamydia)

Most communicable diseases are easily treatable. If the medical tests are positive for a communicable disease, the Civil Surgeon will recommend a course of treatment. Some medical conditions are not easily treatable. However, you may still receive adjustment of status by filing a waiver application. You are eligible for a waiver if:

• You are the spouse or unmarried son or daughter or the minor, unmarried adopted child of a U.S. citizen or LPR; or
  
  
• You have a son or daughter or lawfully adopted child who is a U.S. citizen or LPR; or
  
  
• You are eligible for classification as a self-petitioning spouse or child (including your derivative children) because of abuse.

The waiver may be granted according to the terms and conditions (which can include posting a bond) determined necessary by USCIS in consultation with public health officials, based on the nature of the medical condition. If you are applying for adjustment of status in the United States, you must file Form I-601, Application for Waiver of Grounds of Excludability, including payment of fee, with the USCIS office considering your adjustment of status application.

If you are applying for an immigrant visa at a U.S. Consular post abroad, you must submit your waiver application to the Consular post that is considering your immigrant visa application. The Consular post will send your waiver application to the overseas USCIS office in that jurisdiction for a decision. If you are applying for admission as a refugee, or for adjustment of status at least 1 year following your initial admission as a refugee or the grant of asylum, you may be granted a waiver for humanitarian reasons, to assure family unity, or when it is otherwise in the public interest. You must file Form I-602, Application by Refugee for Waiver of Ground of Excludability, but you are not required to pay a fee.

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What happens if I test positive for HIV?

In the case of testing positive for the HIV virus, you must file a waiver application according to the above instructions. You must also show that your admission to the U.S.:

• Poses minimal public health danger
• Holds minimal possibility of spread of infection
• Will not incur costs to any government agency without prior consent from that agency.

Note: Individuals seeking admission as refugees from outside the United States are not required to submit documentation of individual eligibility for HIV treatment or health care coverage with Form I-602. They are already considered to have the required consent based on their eligibility for Federally funded programs and the assurances provided to USCIS by HHS.

How do Civil Surgeons and Panel Physicians determine drug abuse or addictions?

Using the CDC guidelines, Civil Surgeons and Panel Physicians review the applicant's medical history during the medical exam and ask questions considered necessary to determine whether or not there is any current or past use of any drugs or other psychoactive substances (other than strictly experimental). Applicants may also be required to undergo additional testing for substance abuse.

If the Panel Physician or Civil Surgeon finds that you have a history of drug use or drug addiction, he or she will discuss the medical treatment options.

There is no waiver available for this condition for most adjustment of status applicants. If you are applying for admission as a refugee from abroad or for adjustment of status 1 year following the initial refugee admission or grant of asylum, you may be granted a waiver for humanitarian reasons, to assure family unity, or when it is otherwise in the public interest. In these cases Form I-602, Application by Refugee for Waiver of Grounds of Excludability, is required, but there is no fee.

USCIS has a Designated Civil Surgeons page which can provide you with links to other helpful resources.

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