Immigration Medical Exams & Form I-693 USCIS Civil Surgeon Seminar Series May 17, 2012 1

Immigration Immigration Medical Exams & Medical Exams &

Form I-693Form I-693

USCIS Civil Surgeon Seminar USCIS Civil Surgeon Seminar SeriesSeries

May 17, 2012May 17, 20121

Immigration Immigration BasicsBasics

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Adjustment of Status Adjustment of Status Process Process

For Immigrants For Immigrants Adjustment of status is the process by which Adjustment of status is the process by which

an individual acquires lawful permanent an individual acquires lawful permanent resident status (or a “Green Card”) while in resident status (or a “Green Card”) while in the U.S.the U.S.

The requirements depend on the category The requirements depend on the category under which the applicant seeks adjustment. under which the applicant seeks adjustment.

Regardless of category, all applicants must be Regardless of category, all applicants must be admissibleadmissible before the adjustment application before the adjustment application can be approved.can be approved.

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AdmissibilityAdmissibility Grounds of Inadmissibility can be found in Grounds of Inadmissibility can be found in

section 212(a) of the Immigration and section 212(a) of the Immigration and Nationality Act (INA). Nationality Act (INA).

Examples are: Medical Grounds; Criminal Examples are: Medical Grounds; Criminal Grounds; Security or Terrorist Grounds; Public Grounds; Security or Terrorist Grounds; Public Charge Grounds; Previous Immigration Charge Grounds; Previous Immigration Violations. Violations.

⇨ ⇨ If an applicant is inadmissible, a waiver may be If an applicant is inadmissible, a waiver may be available. Otherwise, the adjustment will be available. Otherwise, the adjustment will be denied.denied.

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WaiversWaivers

Generally, waivers are available for all Generally, waivers are available for all individuals subject to grounds of medical individuals subject to grounds of medical inadmissibility. Only USCIS may grant a waiver, inadmissibility. Only USCIS may grant a waiver, but typically confers with CDC when medical but typically confers with CDC when medical inadmissibilities are concerned.inadmissibilities are concerned.

Waiver forms and fees differ, depending on the Waiver forms and fees differ, depending on the basis upon which the applicant seeks adjustment. basis upon which the applicant seeks adjustment. (For example, refugees are often exempt from (For example, refugees are often exempt from fees.)fees.)

The standard for granting the waiver varies, The standard for granting the waiver varies, depending on the ground of inadmissibility and depending on the ground of inadmissibility and basis upon which the applicant seeks adjustment.basis upon which the applicant seeks adjustment.

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Health-related Health-related Grounds of Grounds of

InadmissibilityInadmissibility

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Health-related Grounds of Health-related Grounds of InadmissibilityInadmissibility

The following are health-related grounds of The following are health-related grounds of inadmissibility (as defined by INA 212(a)inadmissibility (as defined by INA 212(a)(1)):(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)7

Class A and Class B Class A and Class B ConditionsConditions

Class A medical conditionsClass A medical conditions are are inadmissible inadmissible conditions – these include active conditions – these include active TB, active syphilis, physical or mental TB, active syphilis, physical or mental disorder with associated harmful behavior, disorder with associated harmful behavior, and drug abuse or addictionand drug abuse or addiction

Class B medical conditionsClass B medical conditions are are not not inadmissible inadmissible conditions – these include conditions – these include physical or mental abnormalities, diseases, or physical or mental abnormalities, diseases, or disabilities that constitute a substantial disabilities that constitute a substantial departure from normal health or well-beingdeparture from normal health or well-being

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Why a Medical Exam?Why a Medical Exam?

The purpose of the The purpose of the immigration medical immigration medical exam is to determine exam is to determine whether the applicant whether the applicant has an inadmissible has an inadmissible health condition.health condition.

USCIS makes the USCIS makes the admissibility admissibility determination based on determination based on the civil surgeon’s the civil surgeon’s findings.findings.

The civil surgeon determines whether

the applicant has any Class A or B

medical conditions

The civil surgeon records this

information on Form I-693

The immigration officer reviews Form I-693 as part of the

admissibility determination

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Immigration Medical Immigration Medical ExamExam

The immigration medical examination entails:The immigration medical examination entails:

A review of the applicant’s medical history A review of the applicant’s medical history (including all (including all hospitalizations, institutionalizations for chronic conditions, hospitalizations, institutionalizations for chronic conditions, illnesses or disabilities, psychoactive drug and alcohol use, and illnesses or disabilities, psychoactive drug and alcohol use, and chest X-ray and treatment records if applicant has a history chest X-ray and treatment records if applicant has a history suggestive of TB)suggestive of TB)A review of any other records available to the physician A review of any other records available to the physician (which may be indicative of the applicant’s state of health)(which may be indicative of the applicant’s state of health)A review of systems to determine the presence and A review of systems to determine the presence and severity of any Class A and B conditions severity of any Class A and B conditions (ask specifically (ask specifically about symptoms that suggest cardiovascular, pulmonary, about symptoms that suggest cardiovascular, pulmonary, musculoskeletal, and/or neuropsychiatric disorders)musculoskeletal, and/or neuropsychiatric disorders)A physical examination, including an evaluation of mental A physical examination, including an evaluation of mental status and all relevant diagnostic testsstatus and all relevant diagnostic tests

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Immigration Medical ExamImmigration Medical Exam

In general, all applicants for adjustment In general, all applicants for adjustment of status are required to have, at some of status are required to have, at some point in time during their immigration point in time during their immigration history, a medical exam to determine history, a medical exam to determine admissibility to the U.S. based on health admissibility to the U.S. based on health grounds. grounds. Domestic

Medical ExamOverseas Medical Exam

Who performs? Civil surgeons Panel physicians

Designating Agency?

Designated by USCIS

Designated by State Department

Form used to record results of medical exam

Form I-693 Form DS-2053 and DS-2054

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Report of Medical Report of Medical Examination and Examination and

Vaccination Record (Form I-Vaccination Record (Form I-693)693) Form I-693 is used to Form I-693 is used to

record the results of the record the results of the immigration medical immigration medical exam when conducted by exam when conducted by a civil surgeon in the U.S.a civil surgeon in the U.S.

The current version of The current version of Form I-693 is available at Form I-693 is available at http://www.uscis.gov/i-693

Generally, civil surgeons Generally, civil surgeons may notmay not use past versions use past versions of Form I-693of Form I-693

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Report of Medical Report of Medical Examination and Examination and

Vaccination Record (Form I-Vaccination Record (Form I-693)693) Form I-693 is generally Form I-693 is generally

valid for a period of valid for a period of one one yearyear from the date it was from the date it was endorsed by the civil endorsed by the civil surgeonsurgeon

Under certain Under certain circumstances, the circumstances, the validity of Form I-693 validity of Form I-693 may be extended beyond may be extended beyond one yearone year

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Role of Centers for Disease Role of Centers for Disease Control and Prevention Control and Prevention

(CDC)(CDC) Determines communicable diseases of public Determines communicable diseases of public

health significance that render an alien health significance that render an alien inadmissible to the U.S. (42 CFR 34); inadmissible to the U.S. (42 CFR 34); determines which vaccines are required.determines which vaccines are required.

Develops and maintains the Develops and maintains the Technical Technical Instructions (TIs)Instructions (TIs) for both panel physicians for both panel physicians and civil surgeons. The TIs set forth the and civil surgeons. The TIs set forth the requirements for the immigration medical requirements for the immigration medical exams. exams.

⇨⇨ The TIs are binding on panel physicians, civil The TIs are binding on panel physicians, civil surgeons, and immigration officers, and have surgeons, and immigration officers, and have the force of regulations.the force of regulations.

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Role of USCISRole of USCIS Verifies that applicants for adjustment of status Verifies that applicants for adjustment of status

have received the required medical exam(s) have received the required medical exam(s) performed by a panel physician or civil surgeon in performed by a panel physician or civil surgeon in accordance with CDC’s Technical Instructions. accordance with CDC’s Technical Instructions. Maintains Form I-693, Report of Medical Examination Maintains Form I-693, Report of Medical Examination

and Vaccination Record.and Vaccination Record. Based on the medical report (Form I-693), determines Based on the medical report (Form I-693), determines

whether there are any grounds of medical whether there are any grounds of medical inadmissibility.inadmissibility.

Adjudicates and grants waiver requests. If the Adjudicates and grants waiver requests. If the waiver is filed for a medical ground of waiver is filed for a medical ground of inadmissibility, USCIS grants the waiver after inadmissibility, USCIS grants the waiver after consultation with CDC (except for vaccination consultation with CDC (except for vaccination waivers).waivers).

Designates civil surgeons.Designates civil surgeons.

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Civil SurgeonsCivil Surgeons

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Role of the Civil SurgeonRole of the Civil Surgeon Must follow the TIs and any updates Must follow the TIs and any updates

(including verifying the applicant’s identity; (including verifying the applicant’s identity; reporting any medical results to the reporting any medical results to the appropriate authority, as required by law)appropriate authority, as required by law)

Must report the results of the medical Must report the results of the medical examination on Form I-693 for immigration examination on Form I-693 for immigration purposespurposes

Notify USCIS if contact information has Notify USCIS if contact information has changedchanged

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Professional Qualifications Professional Qualifications Required for Civil Surgeon Required for Civil Surgeon

DesignationDesignationA physician may be designated as a civil A physician may be designated as a civil

surgeon if he or she meets the following surgeon if he or she meets the following professional requirements: professional requirements:

Currently licensed M.D. or D.O. in the Currently licensed M.D. or D.O. in the State in which he or she practicesState in which he or she practices

Has 4 years of professional experience, Has 4 years of professional experience, not including residency or other trainingnot including residency or other training

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Applying for Civil Surgeon Applying for Civil Surgeon DesignationDesignation

To apply for designation, a physician should To apply for designation, a physician should submit the following documents to the USCIS submit the following documents to the USCIS District Office having jurisdiction over the area in District Office having jurisdiction over the area in which he or she intends to practice: which he or she intends to practice:

1) Letter to the District Director requesting 1) Letter to the District Director requesting considerationconsideration

2) Copy of a current medical license 2) Copy of a current medical license 3) A current resume that shows 4 years of 3) A current resume that shows 4 years of

professional experience, not including a residency or other professional experience, not including a residency or other trainingtraining

4) Proof of U.S. citizenship or lawful status in the 4) Proof of U.S. citizenship or lawful status in the United StatesUnited States

5) Two signature cards showing name typed and 5) Two signature cards showing name typed and signature belowsignature below

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Blanket Designation of Blanket Designation of Health Department Health Department

PhysiciansPhysicians Physicians at health departments who meet the civil Physicians at health departments who meet the civil

surgeon professional qualifications are granted blanket surgeon professional qualifications are granted blanket designation as civil surgeons designation as civil surgeons onlyonly for the limited purpose for the limited purpose of completing the vaccination portion of Form I-693 for of 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

No application is requiredNo application is required – as long as the physician is on – as long as the physician is on the roster at a local or State health department and meets the roster at a local or State health department and meets the professional qualifications of a civil surgeon, he or she the professional qualifications of a civil surgeon, he or she may be considered a blanket-designated civil surgeonmay be considered a blanket-designated civil surgeon

If a refugee needs to undergo the entire immigration If a refugee needs to undergo the entire 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. medical examination (A refugee who enters the U.S. with a Class A condition will need a complete medical with 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 In this circumstance, only the vaccination page and

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

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Completing Form Completing Form I-693: General I-693: General

OverviewOverview

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Completing Form I-693Completing Form I-693 Main objective is to Main objective is to

correctly complete Form I-correctly complete Form I-693 the 693 the first timefirst time

Spending time in the Spending time in the beginning to ensure the beginning to ensure the form is correctly completed form is correctly completed will save time later will save time later (reduces chance the form (reduces chance the form will be returned by USCIS)will be returned by USCIS)

Ultimately saves time for Ultimately saves time for civil surgeons, applicants, civil surgeons, applicants, and USCISand USCIS

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Completing Form I-693 : Completing Form I-693 : Part 1Part 1

Part 1 should be completed Part 1 should be completed by the applicant by the applicant

Civil surgeons Civil surgeons maymay complete Part 1 for complete Part 1 for applicants as long as applicants as long as applicants review accuracy applicants review accuracy of information before of information before signing the Applicant’s signing the Applicant’s CertificationCertification

Civil surgeons may make Civil surgeons may make annotations in Part 1 if annotations in Part 1 if there are significant there are significant discrepancies between discrepancies between Part 1 and the applicant ID Part 1 and the applicant ID presentedpresented

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Applicant Signature:Applicant Signature: Applicants Applicants should not should not

signsign until directed to do until directed to do so by the civil surgeon so by the civil surgeon after the applicant has after the applicant has met all health follow-up met all health follow-up requirementsrequirements

For children under 14 For children under 14 years old:years old: Parents or Parents or legal guardians may sign legal guardians may sign Form I-693 for the Form I-693 for the applicantapplicant

For children 14 years For children 14 years and over:and over: The applicant The applicant must sign Form I-693must sign Form I-693

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Verifying Identity:Verifying Identity: Applicants are Applicants are requiredrequired to to

bring government-issued bring government-issued photo ID to the immigration photo ID to the immigration medical exammedical exam

Civil surgeons should verify Civil surgeons should verify the identity of the applicant the identity of the applicant to ensure that the to ensure that the individual undergoing the individual undergoing the medical exam is the same medical exam is the same individual listed in Part 1individual listed in Part 1

New!New! Civil surgeons should Civil surgeons should note the form of applicant note the form of applicant ID presented and ID ID presented and ID number (if applicable) in number (if applicable) in Part 1Part 1

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Completing Form I-693: Completing Form I-693: Part 2Part 2

Part 2 provides a Part 2 provides a summary to the summary to the immigration officer immigration officer of the results of the of the results of the medical exammedical exam

Civil surgeons Civil surgeons should complete should complete Part 2 at the Part 2 at the conclusionconclusion of the of the medical examination medical examination (after any follow-up (after any follow-up is completed)is completed)

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Part 3 should be Part 3 should be completed by the civil completed by the civil surgeonsurgeon

Civil surgeons should Civil surgeons should only sign and date Form only sign and date Form I-693 at the conclusionI-693 at the conclusion of of the medical examination the medical examination (after all follow-up (after all follow-up evaluation and treatment evaluation and treatment is completed)is completed)

⇨⇨ The “testing age” is The “testing age” is considered the age of the considered the age of the applicant on the date of applicant on the date of the civil surgeon’s the civil surgeon’s signaturesignature

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The civil surgeon’s The civil surgeon’s signature in Part 3 signature in Part 3 must be an must be an originaloriginal signaturesignature

Exception:Exception: A blanket-A blanket-designated civil surgeon at designated civil surgeon at a health department may a health department may provide an provide an original or original or stampedstamped signature, but it signature, but it must be the signature of the must be the signature of the physician and accompanied physician and accompanied by the official by the official stamp or stamp or raised sealraised seal of the health of the health departmentdepartment

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Completing Form I-693: Completing Form I-693: Top of pages 2-5Top of pages 2-5

New!New! Fields Fields added at the top added at the top of pages 2-5 of of pages 2-5 of Form I-693Form I-693

Civil surgeon should check to make sure that these fields are completed

Applicant should fill in his or her name and A-Number, if any

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Completing Form I-693: Completing Form I-693: Civil Surgeon WorksheetCivil Surgeon Worksheet

The Civil Surgeon The Civil Surgeon Worksheet (pages 2-Worksheet (pages 2-5 of Form I-693) 5 of Form I-693) encompasses the encompasses the medical aspect of the medical aspect of the immigration medical immigration medical examination. examination.

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The Civil Surgeon Worksheet The Civil Surgeon Worksheet is divided into is divided into SIXSIX sections sections (followed by the Vaccination (followed by the Vaccination Record): Record):

Section 1. Communicable Section 1. Communicable Diseases of Public Health Diseases of Public Health SignificanceSignificanceSection 2. Physical and Section 2. Physical and Mental Disorders with Mental Disorders with Associated Harmful BehaviorAssociated Harmful BehaviorSection 3. Drug Abuse/Drug Section 3. Drug Abuse/Drug AddictionAddictionSection 4. Other Medical Section 4. Other Medical ConditionsConditions

Generally, Generally, all of these sections all of these sections must be completed (but there must be completed (but there are exceptions).are exceptions).

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Civil Surgeon Worksheet Civil Surgeon Worksheet (cont’d):(cont’d):

Section 5. Referral to Section 5. Referral to Health Department or Health Department or Other DoctorOther DoctorSection 6. Referral Section 6. Referral Evaluation Evaluation

These sections should These sections should onlyonly be completed if a referral be completed if a referral was made during the was made during the immigration medical exam.immigration medical exam.

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Completing Form I-693: Completing Form I-693: Final ReviewFinal Review

At the end of the At the end of the immigration medical immigration medical exam:exam:Ensure that all follow-up Ensure that all follow-up evaluation and treatment evaluation and treatment is completedis completedEnsure that all Ensure that all Findings/Results boxes Findings/Results boxes are completed for each are completed for each section section Ensure that Part 2 Ensure that Part 2 (“Summary of Medical (“Summary of Medical Examination”) is Examination”) is completedcompleted

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Completing Form I-693: Completing Form I-693: Civil Surgeon’s CertificationCivil Surgeon’s CertificationThe last action on Form I-The last action on Form I-693 should be the civil 693 should be the civil surgeon’s signature and surgeon’s signature and date in Part 3.date in Part 3.

The civil surgeon should The civil surgeon should make make two copies two copies of the of the completed and signed Form completed and signed Form I-693, and any supporting I-693, and any supporting documentation that will be documentation that will be submitted to USCIS. submitted to USCIS.

The civil surgeon should The civil surgeon should keep one copy.keep one copy.

The applicant should The applicant should receive one copy.receive one copy.

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Completing Form I-693: Completing Form I-693: Civil Surgeon’s CertificationCivil Surgeon’s CertificationThe original Form I-693 and The original Form I-693 and any supporting documents any supporting documents should be placed into an should be placed into an envelope and sealed. On the envelope and sealed. On the front of the envelope, write front of the envelope, write in capital letters: “DO NOT in capital letters: “DO NOT OPEN. FOR USCIS USE OPEN. FOR USCIS USE ONLY.”ONLY.”

On the back of the envelope, On the back of the envelope, the civil surgeon should the civil surgeon should write his or her initials write his or her initials across the seal where the across the seal where the flap and the envelope meet. flap and the envelope meet.

(See Form I-693 (See Form I-693 instructions.)instructions.)

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Frequently Asked Frequently Asked QuestionsQuestions

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Frequently Asked Questions Frequently Asked Questions

Q:Q: What is the role of previous test results What is the role of previous test results and validity of those results?and validity of those results?

A:A: The TIs indicate that it is the responsibility of the civil surgeon to ensure The TIs indicate that it is the responsibility of the civil surgeon to ensure that the person undergoing the immigration medical exam is the same that the person undergoing the immigration medical exam is the same person as the one applying for immigration benefits (see Role of Civil person as the one applying for immigration benefits (see Role of Civil Surgeon in the Introduction and Background section of the TIs for Civil Surgeon in the Introduction and Background section of the TIs for Civil Surgeons at: Surgeons at: http://www.cdc.gov/immigrantrefugeehealth/exams/ti/civil/technical-instructions/civil-surgeons/introduction-background.html) )

In addition, the immigration medical exam is used as a “snapshot in time” In addition, the immigration medical exam is used as a “snapshot in time” to assess an applicant’s admissibility as part of the adjustment to assess an applicant’s admissibility as part of the adjustment application. In order for the medical exam to be relied upon as a snapshot application. In order for the medical exam to be relied upon as a snapshot in time, assessments of all relevant medical conditions and vaccinations in time, assessments of all relevant medical conditions and vaccinations received should be made received should be made at the time of the medical examat the time of the medical exam. .

For this reason, medical tests outside of the immigration medical For this reason, medical tests outside of the immigration medical examination are not accepted by USCIS. (However, records of prior examination are not accepted by USCIS. (However, records of prior vaccinations received may be presented to and used by the civil surgeon vaccinations received may be presented to and used by the civil surgeon to update the applicant’s vaccination record on Form I-693.)to update the applicant’s vaccination record on Form I-693.)

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Frequently Asked Questions Frequently Asked Questions

Q:Q: What should I do if an applicant is deferred What should I do if an applicant is deferred inspection by CBP and comes to me for an inspection by CBP and comes to me for an immigration medical examination?immigration medical examination?

A: A: Customs and Border Protection (CBP) officers inspect individuals for Customs and Border Protection (CBP) officers inspect individuals for admission or parole at U.S. ports of entry. A CBP officer may require an admission or parole at U.S. ports of entry. A CBP officer may require an individual to undergo an immigration medical exam, for instance, if an individual to undergo an immigration medical exam, for instance, if an individual’s required medical report completed by a panel physician is individual’s required medical report completed by a panel physician is expired, or to confirm whether or not an individual has an inadmissible expired, or to confirm whether or not an individual has an inadmissible health condition.health condition.

In this case, the CBP officer may require the individual to undergo an In this case, the CBP officer may require the individual to undergo an immigration medical examination outside the U.S. (to be performed by a immigration medical examination outside the U.S. (to be performed by a panel physician) or inside the U.S. (to be performed by a civil surgeon). If panel physician) or inside the U.S. (to be performed by a civil surgeon). If the applicant is allowed to undergo the exam inside the U.S., then he or she the applicant is allowed to undergo the exam inside the U.S., then he or she has been granted deferred inspection and must return to CBP for inspection has been granted deferred inspection and must return to CBP for inspection after completing the medical exam. after completing the medical exam.

If a civil surgeon sees an applicant who has been granted deferred If a civil surgeon sees an applicant who has been granted deferred inspection by CBP, he or she should perform the inspection by CBP, he or she should perform the entireentire medical examination, medical examination, not just part of the exam, as he or she normally would on Form I-693.not just part of the exam, as he or she normally would on Form I-693.

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Questions?Questions?

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Contact InformationContact Information For questions on civil surgeon designation, Form For questions on civil surgeon designation, Form

I-693, or immigration issues in general, please I-693, or immigration issues in general, please contact the civil surgeon coordinator in your contact the civil surgeon coordinator in your jurisdictionjurisdiction

Civil Surgeon Locator (public listing of civil Civil Surgeon Locator (public listing of civil surgeons): surgeons): Go to: Go to: www.uscis.gov and c and click the link for “lick the link for “FindFind A A

Medical Doctor (Civil Surgeon)”Medical Doctor (Civil Surgeon)” on the left on the left side of the pageside of the page

Call the Call the UUSCIS National Customer Service CenterSCIS National Customer Service Center at 1-800-375-5283 and follow the instructions to hear at 1-800-375-5283 and follow the instructions to hear a recorded listing of civil surgeons in your areaa recorded listing of civil surgeons in your area

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Contact InformationContact Information

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/exams/ti/civil/technical-instructions-civil-surgeons.html

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Documents

Immigration Medical Exams & Form I-693 USCIS Civil Surgeon Seminar Series May 17, 2012 1