Immigration Medical Exams & Form I-693 USCIS Civil Surgeon Seminar Series June 12, 2012 1

Immigration Immigration Medical Exams & Medical Exams &

Form I-693Form I-693

USCIS Civil Surgeon Seminar USCIS Civil Surgeon Seminar SeriesSeries

June 12, 2012June 12, 20121

Overview: Health-related Overview: Health-related Grounds of Grounds of

InadmissibilityInadmissibility The following are health-related The following are health-related

grounds of inadmissibility (as grounds of inadmissibility (as defined by INA 212(a)(1)):defined by INA 212(a)(1)):

Communicable disease of public health Communicable disease of public health significance (Class A)significance (Class A)

Failure to show proof of required Failure to show proof of required vaccinations vaccinations (for lawful permanent (for lawful permanent resident applicants ONLY)resident applicants ONLY)

Physical or mental disorder with Physical or mental disorder with associated harmful behavior (Class A)associated harmful behavior (Class A)

Drug abuse or addiction (Class A)Drug abuse or addiction (Class A)

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Vaccination Vaccination RequirementsRequirements

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Completing Form I-693: Completing Form I-693: Vaccination RecordVaccination Record

Overview:Overview:All applicants applying for All applicants applying for adjustment of status must show adjustment of status must show proof that they have received proof that they have received the vaccinations required for the vaccinations required for immigration purposesimmigration purposes

Some vaccinations are Some vaccinations are specifically required by statute; specifically required by statute; others are determined by CDC others are determined by CDC

CDC uses specific vaccination CDC uses specific vaccination criteria to determine whether a criteria to determine whether a certain vaccine should be certain vaccine should be required for immigration required for immigration purposes*purposes*

*For more information, see: *For more information, see: http://www.cdc.gov/immigrantrefugeehealth/laws-regs/vaccination-immigration/revised-vaccination-criteria-immigration.html 4

Vaccination Criteria Vaccination Criteria for U.S. Immigrationfor U.S. Immigration

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The vaccine must be age-appropriate* for the The vaccine must be age-appropriate* for the immigrant applicant immigrant applicant

The vaccine must protect against a disease The vaccine must protect against a disease that has the potential to cause an outbreakthat has the potential to cause an outbreak

The vaccine must protect against a disease The vaccine must protect against a disease that has been eliminated or is in the process that has been eliminated or is in the process of being eliminated in the United States. of being eliminated in the United States.

*The Advisory Committee on Immunization Practices (ACIP) recommends *The Advisory Committee on Immunization Practices (ACIP) recommends vaccines for a certain age range in the general U.S. public. These ACIP vaccines for a certain age range in the general U.S. public. These ACIP recommendations will be used to decide which vaccines are age-recommendations will be used to decide which vaccines are age-appropriate for the general immigrant population.appropriate for the general immigrant population.


A table of all currently A table of all currently required vaccinations for required vaccinations for change of status change of status applicants, based on age*, applicants, based on age*, is available in the on-line is available in the on-line version of CDC's Technical version of CDC's Technical Instructions at Instructions at http://www.cdc.gov/immigrantrefugeehealth/exams/ti/civil/vaccination-civil-technical-instructions.html

The applicant’s aThe applicant’s age ge at the at the time of the medical time of the medical examination examination is used to is used to determine which vaccines determine which vaccines are age-appropriate to are age-appropriate to administeradminister6


Recent updates to the Recent updates to the Vaccination TI’s:Vaccination TI’s:

As of November 2010, As of November 2010, the flu vaccine is required the flu vaccine is required for for ALLALL applicants 6 applicants 6 months of age and older months of age and older during the flu season*, during the flu season*, unless contraindicatedunless contraindicated

* For immigration * For immigration purposes, the flu season is purposes, the flu season is Oct 1 – Mar 31 annuallyOct 1 – Mar 31 annually

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Form I-693 includes a Form I-693 includes a vaccination record, vaccination record, which the civil surgeon which the civil surgeon will complete as part of will complete as part of the immigration medical the immigration medical exam. The vaccination exam. The vaccination record will indicate record will indicate whether the applicant whether the applicant has met the vaccination has met the vaccination requirement for requirement for immigration purposes, immigration purposes, and whether a waiver of and whether a waiver of those requirements is those requirements is requested.requested.


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The civil surgeon should The civil surgeon should ensure the vaccination ensure the vaccination record reflects:record reflects:

(1) (1) The applicant’s vaccine The applicant’s vaccine history (including dates history (including dates of properly documented of properly documented vaccinations)vaccinations)

(2) (2) Any vaccines Any vaccines administered by the civil administered by the civil surgeon during the surgeon during the immigration medical immigration medical exam, ANDexam, AND

(3) (3) Any vaccines that were Any vaccines that were not medically not medically appropriate to appropriate to administer during the administer during the immigration medical immigration medical examexam


A vaccine should A vaccine should notnot be be administered if it is administered if it is notnot medically medically appropriateappropriate for the applicant for the applicant becausebecause

It is It is not age appropriate not age appropriate to to administeradminister

It is It is contraindicatedcontraindicated for the for the applicantapplicant

There is an There is an insufficient time insufficient time intervalinterval, either to administer the , either to administer the next dose in a vaccine series or to next dose in a vaccine series or to complete the vaccine series on the complete the vaccine series on the day of the immigration medical day of the immigration medical examexam

It is It is not flu seasonnot flu season (for the influenza (for the influenza vaccine)vaccine)

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The The ““contraindicationcontraindication” ” box for box for a particular vaccine should be a particular vaccine should be marked if it is not administered marked if it is not administered becausebecause

The particular vaccine is The particular vaccine is medically contraindicatedmedically contraindicated for for the applicant, the applicant,

OROR

A A precautionprecaution exists, and the exists, and the civil surgeon decides that the civil surgeon decides that the precaution precludes vaccine precaution precludes vaccine administration. administration.

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Definitions from the Technical Definitions from the Technical Instructions:Instructions:

A A contraindicationcontraindication is a condition in is a condition in a recipient which is likely to result a recipient which is likely to result in a life-threatening problem if the in a life-threatening problem if the vaccine is given. (See TIs for vaccine is given. (See TIs for examples.)examples.)

A A precautionprecaution is a condition in a is a condition in a recipient that might increase the recipient that might increase the chance of a serious adverse chance of a serious adverse reaction if the vaccine is reaction if the vaccine is administered, or a condition that administered, or a condition that might compromise the ability of the might compromise the ability of the vaccine to produce immunity. (See vaccine to produce immunity. (See TIs for examples.)TIs for examples.)

The civil surgeon should annotate The civil surgeon should annotate the reason for the contraindication the reason for the contraindication in the Remarks section.in the Remarks section.

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The The ““insufficient time intervalinsufficient time interval” ” box for a particular vaccine should box for a particular vaccine should be marked if it is not administered be marked if it is not administered becausebecause

The vaccine is one in which a series The vaccine is one in which a series is not complete (only one dose of is not complete (only one dose of each vaccine series is required at the each vaccine series is required at the immigration medical exam); immigration medical exam);

OROR

The most recent dose in a series The most recent dose in a series was too recent for the next dose to was too recent for the next dose to be administered; be administered;

OR OR

An applicant has received any live An applicant has received any live injectable vaccine or the live injectable vaccine or the live intranasal influenza vaccine within 4 intranasal influenza vaccine within 4 weeks of the visit to the civil weeks of the visit to the civil surgeon’s office.surgeon’s office.

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Note on Vaccination Note on Vaccination Assessment and Assessment and

Tuberculosis Screening Tuberculosis Screening TestsTestsSpacing of Live Vaccines and Tuberculin Skin Spacing of Live Vaccines and Tuberculin Skin

Test (TST):Test (TST):

All vaccines can be given on the same day as a TST or any All vaccines can be given on the same day as a TST or any time time afterafter TST is applied. TST is applied.

However, if MMR, varicella, or live attenuated intranasal However, if MMR, varicella, or live attenuated intranasal influenza vaccine (LAIV) is given influenza vaccine (LAIV) is given beforebefore TST, at least 4 TST, at least 4 weeks is recommended before administering the TST.weeks is recommended before administering the TST.

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Note on Vaccination Note on Vaccination Assessment and Assessment and

Tuberculosis Screening Tuberculosis Screening TestsTestsCan blood be drawn for IGRA testing Can blood be drawn for IGRA testing afterafter live-virus live-virus

vaccine administration?vaccine administration?

As with TST, live virus vaccines might affect IGRA test resultsAs with TST, live virus vaccines might affect IGRA test resultsEffect not yet studied (June 2012)Effect not yet studied (June 2012)Until more information available, test as follows:Until more information available, test as follows:

Either same day as live-virus vaccine Either same day as live-virus vaccine

OROR 4-6 weeks after live-virus vaccine administration, and4-6 weeks after live-virus vaccine administration, and At least one month after smallpox vaccination At least one month after smallpox vaccination

Source: Source: http://www.cdc.gov/tb/publications/factsheets/testing/IGRA.pdf

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Steps for performing the Steps for performing the vaccination assessment vaccination assessment for U.S. immigration for U.S. immigration purposes: purposes:

STEP 1STEP 1: If the applicant presents : If the applicant presents valid documentation of prior valid documentation of prior immunization, then annotate the immunization, then annotate the datedate the applicant received the the applicant received the vaccine in the appropriate row. vaccine in the appropriate row. Dates should include Dates should include month, month, day, and yearday, and year, otherwise the , otherwise the prior vaccine is considered prior vaccine is considered invalid.invalid.

The civil surgeon should use his The civil surgeon should use his or her best judgment to determine or her best judgment to determine whether documentation of prior whether documentation of prior immunization is valid or not.immunization is valid or not.

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Vaccination assessment Vaccination assessment (cont’d): (cont’d):

STEP 2STEP 2: If the applicant has : If the applicant has completed the vaccination completed the vaccination series, mark an “X” in the series, mark an “X” in the corresponding box in the corresponding box in the “Completed Series” column.“Completed Series” column.

NOTE: The civil surgeon is NOTE: The civil surgeon is required to administer only required to administer only one one dose dose of each vaccine series at the of each vaccine series at the time of the immigration time of the immigration examination. Completion of a examination. Completion of a vaccine series is vaccine series is not required not required to to conclude the medical exam, since conclude the medical exam, since this could require multiple visits to this could require multiple visits to the civil surgeon and could lead to the civil surgeon and could lead to unnecessary delay in the unnecessary delay in the immigration process.immigration process.

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STEP 3STEP 3: For any incomplete : For any incomplete vaccination series, determine what vaccination series, determine what vaccines the applicant needs based vaccines the applicant needs based on the applicant’s age on the applicant’s age at the time of at the time of the medical exam.the medical exam.

For those vaccines For those vaccines not age-not age-appropriateappropriate, mark the , mark the corresponding box in the “Not corresponding box in the “Not Age Appropriate” column.Age Appropriate” column.

Check the vaccination table in the Check the vaccination table in the TIs and the age-appropriate ACIP* TIs and the age-appropriate ACIP* vaccination schedule forvaccination schedule for

specific vaccine indications specific vaccine indications contraindications and precautionscontraindications and precautions

*Advisory Committee on Immunization *Advisory Committee on Immunization PracticesPractices

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ACIP* Schedule: ACIP* Schedule: Persons 0-6 Years of AgePersons 0-6 Years of Age

Accessible at: Accessible at: http://www.cdc.gov/vaccines/rec://www.cdc.gov/vaccines/recs/schedules/downloads/childs/schedules/downloads/child/0-6yrs-schedule-pr.pdf/0-6yrs-schedule-pr.pdf

Use yellow boxes for Use yellow boxes for general populationgeneral population


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ACIP* Schedule: ACIP* Schedule: Persons 7-18 Years of AgePersons 7-18 Years of Age

Accessible at: Accessible at: http://www.cdc.gov/vaccines/http://www.cdc.gov/vaccines/recs/schedules/downloads/chrecs/schedules/downloads/child/7-18yrs-schedule-pr.pdfild/7-18yrs-schedule-pr.pdf

Use yellow boxes for general Use yellow boxes for general populationpopulation


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Recommended Adult Recommended Adult Immunization Schedule, Immunization Schedule,

Page 1 of 5Page 1 of 5

Available at: http://www.cdc.gov/vaccines/recs/schedules/downloads/adult/adult-schedule.pdf Available at: http://www.cdc.gov/vaccines/recs/schedules/downloads/adult/adult-schedule.pdf

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STEP 4STEP 4: All remaining vaccines : All remaining vaccines are age-appropriate. Determine are age-appropriate. Determine whether any age-appropriate whether any age-appropriate vaccines are vaccines are not medically not medically appropriate appropriate to receive because:to receive because:

Vaccine is contraindicated Vaccine is contraindicated or a precaution exists that or a precaution exists that precludes administration precludes administration of the vaccine (mark the of the vaccine (mark the “Contraindication” box in “Contraindication” box in the appropriate row and the appropriate row and annotate the reason in the annotate the reason in the Remarks section);Remarks section);

Time interval is Time interval is insufficient; orinsufficient; or

It is not flu season.It is not flu season.

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STEP 5STEP 5: Administer : Administer remaining age-appropriate remaining age-appropriate vaccines that are medically vaccines that are medically appropriate to receive. appropriate to receive. Annotate the date (month, Annotate the date (month, day, and year) in the day, and year) in the appropriate box.appropriate box.

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STEP 6STEP 6: Check the appropriate : Check the appropriate Results box below the vaccine Results box below the vaccine chart.chart.Applicant may be eligible for blanket Applicant may be eligible for blanket waiver(s) waiver(s) – Check this box if any boxes – Check this box if any boxes under “Not Medically Appropriate” under “Not Medically Appropriate” heading are checkedheading are checkedApplicant will request an individual Applicant will request an individual waiver based on religious or moral waiver based on religious or moral convictionsconvictionsVaccine history complete for each Vaccine history complete for each vaccine, all requirements met vaccine, all requirements met – Check – Check this box if the applicant has completed this box if the applicant has completed the series for all vaccines on Vaccination the series for all vaccines on Vaccination Record, not only vaccines required at Record, not only vaccines required at time of the medical examtime of the medical examApplicant does not meet Applicant does not meet immunization requirements immunization requirements – Check – Check this box if the applicant has not received this box if the applicant has not received all required vaccinesall required vaccines

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There are two types of waivers:There are two types of waivers:(1) (1) blanket waivers blanket waivers – separate – separate form or fee is not requiredform or fee is not required(2) (2) individual waivers individual waivers – separate – separate form is required; fee may also be form is required; fee may also be requiredrequired

For most applicants other than For most applicants other than those requesting an individual those requesting an individual waiver, the Results box “Applicant waiver, the Results box “Applicant may be eligible for blanket may be eligible for blanket waiver(s)” will be checkedwaiver(s)” will be checked

Before completing the Before completing the vaccination assessment, please vaccination assessment, please make sure:make sure:There is at least one mark in There is at least one mark in every rowevery row in the vaccine chart in the vaccine chartThe appropriate results box below The appropriate results box below the vaccine chart is checkedthe vaccine chart is checked

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Waiver of the Waiver of the Vaccination RequirementsVaccination Requirements

An applicant who refuses to receive vaccinations may An applicant who refuses to receive vaccinations may be eligible for an individual waiver on religious or be eligible for an individual waiver on religious or moral grounds under the following circumstances: moral grounds under the following circumstances:

The applicant must be opposed to vaccinations in The applicant must be opposed to vaccinations in anyany form,form,

The objection must be based on religious beliefs or moral The objection must be based on religious beliefs or moral convictions, convictions, andand

The religious or moral beliefs must be sincere.The religious or moral beliefs must be sincere.

If an applicant refuses to receive vaccinations, the If an applicant refuses to receive vaccinations, the civil surgeon should mark the Results box “Applicants civil surgeon should mark the Results box “Applicants will request an individual waiver based on religious or will request an individual waiver based on religious or moral convictions” moral convictions”

⇨ ⇨ The individual waiver must be filed separately on the The individual waiver must be filed separately on the appropriate waiver form (Form I-601 or I-602), with appropriate waiver form (Form I-601 or I-602), with the appropriate fee and necessary evidence.the appropriate fee and necessary evidence.

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Special Note on RefugeesSpecial Note on Refugees

Refugees undergo an overseas medical exam as part of Refugees undergo an overseas medical exam as part of refugee processing; they are refugee processing; they are not required not required to receive to receive vaccines at that timevaccines at that time

Immigration medical examination in the U.S.:Immigration medical examination in the U.S.: The vast majority of refugees need only a vaccination The vast majority of refugees need only a vaccination

assessmentassessment Only refugees who entered the United States with Class A Only refugees who entered the United States with Class A

conditions are required to undergo a full medical examination conditions are required to undergo a full medical examination in the U.S. in the U.S.

NoteNote: Refugees have the option of going to participating health : Refugees have the option of going to participating health departments to complete the vaccination assessment. State and departments to complete the vaccination assessment. State and local health departments are blanket designated as civil surgeons local health departments are blanket designated as civil surgeons to perform the vaccination assessment of refugees adjusting status.to perform the vaccination assessment of refugees adjusting status.

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Blanket Civil Surgeon Blanket Civil Surgeon Designation Designation

of Health Departmentsof Health Departments USCIS granted a blanket civil surgeon designation to all USCIS granted a blanket civil surgeon designation to all

State and local health departments that have a physician State and local health departments that have a physician who meets the civil surgeon professional qualifications: The who meets the civil surgeon professional qualifications: The blanket designation is blanket designation is onlyonly for the limited purpose of for the limited purpose of completing the vaccination portion of Form I-693 for completing the vaccination portion of Form I-693 for refugees adjusting status refugees adjusting status

Participation in the blanket designation is optional; health Participation in the blanket designation is optional; health department physicians are department physicians are not requirednot required to act as civil to act as civil surgeonssurgeons

Blanket designation means Blanket designation means no application for civil surgeon no application for civil surgeon designation is requireddesignation is required; health departments may act as civil ; health departments may act as civil surgeons immediately if they meet the requirements for the surgeons immediately if they meet the requirements for the blanket designation blanket designation

If a refugee needs to undergo the If a refugee needs to undergo the entireentire immigration immigration medical exam, he or she must seek a civil surgeon medical exam, he or she must seek a civil surgeon designated under the standard application processdesignated under the standard application process

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Refugees Applying for Refugees Applying for Adjustment of Status Adjustment of Status

Health department physicians acting as civil Health department physicians acting as civil surgeons under surgeons under

the blanket designation may the blanket designation may ONLYONLY perform the perform the vaccination vaccination

assessment and assessment and ONLYONLY for a refugee who: for a refugee who: Is applying for adjustment of status under INA 209,Is applying for adjustment of status under INA 209, Already had an immigration medical examination Already had an immigration medical examination

overseas, overseas, ANDAND Is not required to repeat any part of the immigration Is not required to repeat any part of the immigration

medical examination (A refugee who enters the U.S. with medical examination (A refugee who enters the U.S. with a Class A condition will need a complete medical a Class A condition will need a complete medical examination performed by a designated civil surgeon.)examination performed by a designated civil surgeon.)

Completing Form I-693:Completing Form I-693: In this circumstance, only the vaccination page and page In this circumstance, only the vaccination page and page

1 of Form I-693 need to be completed 1 of Form I-693 need to be completed

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Special Note on K and V Special Note on K and V Nonimmigrant Visa HoldersNonimmigrant Visa Holders

K and V nonimmigrant visa holders are close family K and V nonimmigrant visa holders are close family members of U.S. citizens and lawful permanent residents members of U.S. citizens and lawful permanent residents (green card holders)(green card holders)

Certain Ks and Vs undergo an overseas medical exam as Certain Ks and Vs undergo an overseas medical exam as part of visa processing; they part of visa processing; they maymay receive vaccines receive vaccines overseasoverseas

Immigration medical examination in the U.S.:Immigration medical examination in the U.S.: Ks and Vs who had an overseas medical exam are Ks and Vs who had an overseas medical exam are not required not required

to undergo a full medical examination in the U.S. if the to undergo a full medical examination in the U.S. if the adjustment application is filed within one year of the overseas adjustment application is filed within one year of the overseas medical exam medical exam andand the overseas medical exam did not reveal a the overseas medical exam did not reveal a Class A condition (or the individual received a waiver of Class A condition (or the individual received a waiver of inadmissibility and has complied with the waiver’s terms and inadmissibility and has complied with the waiver’s terms and conditions)conditions)

Even if a full examination in the U.S. is not required, Ks and Vs Even if a full examination in the U.S. is not required, Ks and Vs may have to see a civil surgeon to complete the vaccination may have to see a civil surgeon to complete the vaccination requirements if they were not completed as part of the requirements if they were not completed as part of the overseas medical examoverseas medical exam

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Special Note on Asylee Special Note on Asylee DependentsDependents

Certain spouses and children of asylees may undergo Certain spouses and children of asylees may undergo an overseas medical exam; they are an overseas medical exam; they are not required not required to to receive vaccines at that timereceive vaccines at that time

Immigration medical examination in the U.S.:Immigration medical examination in the U.S.: Asylee dependents who had an overseas medical exam are Asylee dependents who had an overseas medical exam are

not required not required to undergo a full medical examination in the to undergo a full medical examination in the U.S. as long as the adjustment application is filed within U.S. as long as the adjustment application is filed within one year of eligibility to file one year of eligibility to file andand the overseas medical exam the overseas medical exam did not reveal a Class A condition did not reveal a Class A condition

Even if a full medical exam in the U.S. is not required, Even if a full medical exam in the U.S. is not required, asylee dependents must still see a civil surgeon* to asylee dependents must still see a civil surgeon* to complete the vaccination assessmentcomplete the vaccination assessment

*Asylee dependents *Asylee dependents cannotcannot go to blanket designated health go to blanket designated health departments for the vaccination assessment; the blanket departments for the vaccination assessment; the blanket civil surgeon designation for health departments only civil surgeon designation for health departments only extends to extends to refugeesrefugees adjusting status. adjusting status.

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U.S. Department of State U.S. Department of State Vaccination Documentation Vaccination Documentation

Worksheet (DS-3025)Worksheet (DS-3025) Completed by DOS-designated panel Completed by DOS-designated panel

physicians at time of overseas medical physicians at time of overseas medical examination for U.S. immigration purposesexamination for U.S. immigration purposes

Acceptable as documentation of proof of Acceptable as documentation of proof of prior vaccinationsprior vaccinations

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Vaccines: ReferencesVaccines: References 2009 Technical Instructions for Vaccination for Civil 2009 Technical Instructions for Vaccination for Civil

SurgeonsSurgeons http://www.cdc.gov/immigrantrefugeehealth/http://www.cdc.gov/immigrantrefugeehealth/

exams/ti/civil/vaccination-civil-technical-exams/ti/civil/vaccination-civil-technical-instructions.htmlinstructions.html

Updated ACIP InformationUpdated ACIP Information www.cdc.gov/vaccines www.cdc.gov/vaccines

CDC Pink Book Epidemiology and Prevention of CDC Pink Book Epidemiology and Prevention of Vaccine-Preventable DiseasesVaccine-Preventable Diseases www.cdc.gov/vaccines/Pubs/pinkbook/www.cdc.gov/vaccines/Pubs/pinkbook/ 12th edition released April 201112th edition released April 2011 Download to eBook readerDownload to eBook reader

Vaccination Guidelines for Pregnant WomenVaccination Guidelines for Pregnant Women www.cdc.gov/vaccines/pubs/preg-guide.htmwww.cdc.gov/vaccines/pubs/preg-guide.htm

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Frequently Asked Frequently Asked QuestionsQuestions

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Frequently Asked Questions Frequently Asked Questions

Q:Q: Can an applicant receive Can an applicant receive age-appropriate age-appropriate vaccinations if she is vaccinations if she is pregnant?pregnant?

A:A: It depends on the vaccination. It depends on the vaccination. Pregnancy is a contraindication Pregnancy is a contraindication for live vaccines. According to for live vaccines. According to the Vaccination TI’s, pregnancy the Vaccination TI’s, pregnancy is is NOTNOT a contraindication for a contraindication for Td, Tdap, inactivated influenza, Td, Tdap, inactivated influenza, or hepatitis B vaccine. See or hepatitis B vaccine. See http://www.cdc.gov/vaccines/puhttp://www.cdc.gov/vaccines/pubs/preg-guide.htm for more bs/preg-guide.htm for more information. information.

When a live vaccination is not When a live vaccination is not administered because of administered because of pregnancy, the contraindication pregnancy, the contraindication box should be checked and the box should be checked and the reason should be noted in the reason should be noted in the Remarks section.Remarks section.

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Frequently Asked Questions Frequently Asked Questions

Q:Q: When assessing the vaccinations an applicant has When assessing the vaccinations an applicant has received, should I count the vaccinations received received, should I count the vaccinations received abroad?abroad?

A:A: Yes. According to the Vaccination TI’s, most vaccines used Yes. According to the Vaccination TI’s, most vaccines used worldwide are from reliable local or international manufacturers so it worldwide are from reliable local or international manufacturers so it is reasonable to assume that any vaccines received abroad are of is reasonable to assume that any vaccines received abroad are of adequate potency. However, the civil surgeon should still ensure that adequate potency. However, the civil surgeon should still ensure that any vaccines administered abroad were done so according to the any vaccines administered abroad were done so according to the ACIP-recommended vaccine schedules. ACIP-recommended vaccine schedules.

Additionally, the civil surgeon should use his or her judgment to Additionally, the civil surgeon should use his or her judgment to determine if documentation of prior immunization is valid.determine if documentation of prior immunization is valid.

If the documentation appears invalid, the prior vaccinations should If the documentation appears invalid, the prior vaccinations should not be recorded on Form I-693, Vaccination Record. The civil surgeon not be recorded on Form I-693, Vaccination Record. The civil surgeon is responsible for administering one dose of any age-appropriate is responsible for administering one dose of any age-appropriate vaccine for which there is no valid record, unless the vaccine is not vaccine for which there is no valid record, unless the vaccine is not medically appropriate (see reasons for blanket waiver).medically appropriate (see reasons for blanket waiver).

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Questions?Questions?

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Contact InformationContact Information

For questions on civil surgeon designation, For questions on civil surgeon designation, Form I-693, or immigration issues in Form I-693, or immigration issues in general, please contact the civil surgeon general, please contact the civil surgeon coordinator in your jurisdictioncoordinator in your jurisdiction

For questions about the Technical For questions about the Technical Instructions and medical exam Instructions and medical exam requirements: requirements: Go to: Go to:

http://www.cdc.gov/immigrantrefugeehealth/exhttp://www.cdc.gov/immigrantrefugeehealth/exams/ti/civil/technical-instructions-civil-ams/ti/civil/technical-instructions-civil-surgeons.html surgeons.html

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Documents

Immigration Medical Exams & Form I-693 USCIS Civil Surgeon Seminar Series June 12, 2012 1