Applicants who have communicable diseases of public health significance are inadmissible.[1] The Department of Health and Human Services (HHS) has designated the following conditions as communicable diseases of public health significance that apply to immigration medical examinations conducted in the United States:[2]

• Gonorrhea;
• Hansen’s Disease (Leprosy), infectious;
• Syphilis, infectious stage; and 
• Tuberculosis (TB), Active—Only a Class A TB diagnosis renders an applicant inadmissible to the United States. Under current Centers for Disease Control and Prevention (CDC)guidelines, Class A TB means TB that is clinically active and communicable. 

What qualifies as a communicable disease of public health significance is determined by HHS, not by USCIS. Any regulatory updates HHS makes to its list of communicable diseases of public health significance are controlling over the list provided in this Part B.

HHS regulations also list two additional general categories of communicable diseases of public health significance.[3] Currently, these provisions only apply to applicants outside the United States who have to be examined by panel physicians:[4]

• Communicable diseases that may make a person subject to quarantine, as listed in a Presidential Executive Order, as provided under Section 361(b) of the Public Health Service Act.[5]
• Communicable diseases that may pose a public health emergency of international concern if they meet one or more of the factors listed in 42 CFR 34.3(d) and for which the Director of the CDC has determined that (A) a threat exists for importation into the United States, and (B) such disease may potentially affect the health of the American public. The determination will be made consistent with criteria established in Annex 2 of the revised International Health Regulations. HHS/CDC's determinations will be announced by notice in the Federal Register.

As of January 4, 2010, human immunodeficiency virus (HIV) infection is no longer defined as a communicable disease of public health significance according to HHS regulations.[6] Therefore, HIV infection does not make the applicant inadmissible on health-related grounds for any immigration benefit adjudicated on or after January 4, 2010, even if the applicant filed the immigration benefit application before January 4, 2010. 

The officer should disregard a diagnosis of HIV infection when determining whether an applicant is inadmissible on health-related grounds. The officer should administratively close any HIV waiver application filed before January 4, 2010. 

The civil surgeon must complete “Findings” boxes for all categories of communicable diseases of public health significance. The civil surgeon may add explanatory remarks; however, the officer should not issue a Request for Evidence (RFE) simply because there are no remarks.

An initial tuberculosis (TB) screening test for showing an immune response to Mycobacterium tuberculosis[7] antigens is required for all applicants 2 years of age or older.[8] According to the Tuberculosis Technical Instructions for Civil Surgeons, applicants under 2 years of age are required to undergo an initial screening test only if the child has signs or symptoms suggestive of TB or has known human immunodeficiency virus (HIV) infection.

The “testing age” is the applicant’s age on the date the civil surgeon completed the medical examination by signing the form, not the age at the time of the adjudication. An officer should not send a RFE for testing if the applicant was properly exempt from the testing requirement due to age at the time of the medical examination. The officer, however, may always require testing if evidence indicates the applicant may have been exposed to TB since the examination.

Initial Screening Test Results

The initial screening test results must be recorded. If the initial screening test was not administered, the exceptions should be clearly annotated in the remarks portion after the “not administered” box in the testing section. The officer should be aware that anyone who previously received the Bacille Calmette-Guérin vaccine[9] must still undergo an initial TB screening test. These applicants are not exempt from the initial screening test. 

The civil surgeon must also annotate the “Initial Screening Test Result and Chest X-Ray Determination” section. If the section indicates that the applicant is medically cleared relating to TB, then no further TB tests are required. In this case, the X-ray section should be left blank.

Positive Screening Results

If the initial screening test is positive, or if the applicant has signs or symptoms of TB or has known HIV infection, a chest X-ray must be performed. Applicants who have chest x-ray findings suggestive of TB, signs or symptoms of TB, or known HIV infection must be referred to the health department of jurisdiction for sputum testing. This referral, testing, and treatment can be a lengthy process, but the civil surgeon cannot sign off on the Report of Immigration Medical Examination and Vaccination Record (Form I-693) until any required steps relating to TB have been completed.

Under the Technical Instructions, a pregnant applicant can defer the chest X-ray until after pregnancy but the civil surgeon may not submit the form until the chest X-ray has been performed, interpreted, and the appropriate follow-up, if required under the Technical Instructions, is completed. If the officer receives an incomplete medical examination for a pregnant applicant, the officer should return the original form to the applicant for corrective action according to established local procedures. 

Referral and Reporting to Health Departments

If a referral is required, the civil surgeon must not sign Form I-693 until the referral evaluation section has been completed and received back from the appropriate health department. If the referral evaluation section is not documented, the officer should issue an RFE for corrective action. Determining whether a referral is required is detailed in the TB Technical Instructions for Civil Surgeons.

An applicant may be required to undergo serological testing for syphilis depending on the applicant’s age and other factors set by CDC. Civil surgeons must consult CDC’s Technical Instructions for Civil Surgeons for current requirements, and to ensure they are using approved screening, testing, and treatment procedures. The testing age is determined by the applicant’s age on the date the civil surgeon completed the immigration medical examination and signed Form I-693, not the age at the time USCIS adjudicates the application.

An applicant may be required to undergo testing for gonorrhea depending on the applicant’s age and other factors set by CDC. Civil surgeons must consult CDC’s Technical Instructions for Civil Surgeons for current requirements, and to ensure they are using approved screening, testing, and treatment procedures. The testing age is determined by the applicant’s age on the date the civil surgeon completed the immigration medical examination and signed Form I-693, not the age at the time USCIS adjudicates the application.

According to the Technical Instructions for Hansen's Disease (Leprosy) for Civil Surgeons, screening for Hansen’s disease includes obtaining medical history with inquiries as to past and present diagnoses of Hansen’s disease, history of skin lesions unresponsive to treatment, and family history of skin lesions or known Hansen’s disease. The physical exam must include a search for signs and lesions consistent with Hansen’s disease, and the civil surgeon must complete the “Findings” portion in Form I-693.

[^ 1] See INA 212(a)(1)(A)(i).

[^ 2] See 42 CFR 34.2(b).

[^ 3] See 42 CFR 34.2(b)(2) and 42 CFR 34.2(b)(3). 

[^ 4] An officer will not encounter such annotations on Report of Immigration Medical Examination and Vaccination Record (Form I-693), but may on the DS-2053/DS-2054.

[^ 5] See Pub. L. 78-410, 58 Stat. 682, 703 (July 1, 1944), as amended, codified at 42 U.S.C. Chapter 6A. The current revised list of quarantinable communicable diseases is available at cdc.gov and archives.gov/federal-register. 

[^ 6] See the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, Pub. L. 110-293 (PDF) (July 30, 2008). See 42 CFR 34.2(b) as amended by 74 FR 56547 (PDF) (Nov. 2, 2009).

[^ 7] Bacteria that cause latent TB infection and TB disease.

[^ 8] For acceptable tests and more information regarding procedures relating to the referral process, see the Tuberculosis Technical Instructions for Civil Surgeons.

[^ 9] Often referred to as the “BCG” vaccine. BCG vaccine is a tuberculosis vaccination that is administered in many countries outside of the United States, especially those with a high TB rate. For more information, see CDC’s website at cdc.gov.

Medical examination and vaccination requirements vary depending on the immigration benefit the person is seeking. 

Most applicants subject to medical grounds of inadmissibility must undergo a medical examination to determine their admissibility. Some applicants, however, do not need to undergo a medical examination unless there is a specific concern. Nonimmigrants, for example, are in this category.

Even if the applicant is not subject to health-related grounds of inadmissibility, the officer may still order a medical examination as a matter of discretion if the evidence indicates that there may be a public health concern.[1] This could apply, for example, when an officer adjudicates a request for parole.[2]

In general, an immigration officer may order a medical examination of an applicant at any time, if the officer is concerned that the applicant may be medically inadmissible.[3] This rule applies regardless of the type of immigration benefit sought, or whether the applicant is applying for a visa, seeking entry at a U.S. port-of-entry, or already in the United States. 

A civil surgeon in the United States can only perform a medical examination for purposes of a benefits application processed within the United States. Similarly, a panel physician abroad can generally only perform a medical examination for purposes of a visa application processed outside the United States. There are limited exceptions where an applicant seeking a benefit application inside the United States does not have to repeat a medical examination performed by a panel physician. The following chart highlights the benefits that require a medical examination and vaccinations, and whether a civil surgeon or panel physician should conduct the medical examination.[4]

Afghan nationals who arrived in the United States under Operation Allies Welcome (OAW)[25] applying for adjustment of status Yes Yes Panel physician or civil surgeon

In general, nonimmigrant visa applicants, nonimmigrants seeking change or extension of status, and Temporary Protected Status (TPS) applicants are only medically examined if the consular officer or immigration officer has concerns as to the applicant’s inadmissibility on health-related grounds. Customs and Border Protection (CBP) officers at ports-of-entry may also require a nonimmigrant arriving with or without a visa to submit to a medical examination to determine whether a medical ground of inadmissibility applies.

While the consular officer may encourage compliance, the consular officer cannot deny a K or V visa for lack of compliance with the vaccination requirements. 

Some panel physicians may perform the vaccination assessment in anticipation of the applicant’s later adjustment of status application.

For nonimmigrants applying for change of status to V status, the civil surgeon may perform the vaccination assessment in anticipation of the applicant’s later adjustment of status application.

K and V nonimmigrants applying for adjustment of status are not required to repeat the medical examination if the application was filed within one year of the date of the original medical examination, and:

• The medical examination did not reveal a Class A medical condition; or 
• The applicant received a conditional waiver in conjunction with the K or V nonimmigrant visa or the change of status to V and the applicant submits evidence of compliance with the waiver terms and conditions.[28]

If a new medical examination is required and reveals a Class A medical condition, a new waiver application will also be required. In such cases, the officer should determine whether the applicant complied with the terms and conditions of the first waiver, if applicable. Such determination should be given considerable weight in the adjudication of a subsequent waiver application.[29]

Even if a new medical examination is not required, applicants must still comply with the vaccination requirements if the vaccination record was not included as part of the original medical examination report. If the vaccination report was properly completed at the time of the overseas examination, the officer may accept the vaccination assessment completed by the panel physician. 

An applicant’s overseas medical examination report completed by a panel physician should already be in the applicant’s A-file. If it is not in the A-file, the officer should request the medical examination report through a Request for Evidence (RFE).

If the applicant was granted a change of status to V in the United States,[30] the medical examination report completed by the civil surgeon should be in the A-file created at the time that the change of status was initially granted. 

By regulation, refugees applying for adjustment of status generally do not need to repeat the entire medical examination if the applicant was already examined by a panel physician for purposes of admission to the United States.[32] Refugees must undergo an additional medical examination only if the original examination by the panel physician revealed a Class A medical condition.

Family members granted refugee status in the United States must submit to a medical examination at the time they seek to adjust their status. 

All refugees must comply with the vaccination requirements at the time of adjustment of status by submitting the relevant parts of the Report of Immigration Medical Examination and Vaccination Record (Form I-693) completed by a designated civil surgeon. A prior vaccination assessment performed by the panel physician cannot be used for purposes of the adjustment of status application.[33]

USCIS granted a blanket civil surgeon designation to state and local health department physicians for the limited purpose of completing the vaccination record for refugees applying for adjustment of status. 

All asylees are required to undergo an immigration medical exam, including vaccination assessment, at time of adjustment.[34]

However, according to USCIS policy developed in consultation with the Centers for Disease Control and Prevention, an asylee dependent who had a medical examination conducted overseas is not required to undergo a new medical exam when applying for adjustment of status if:

• The results of the overseas medical examination are contained in the A-file and no Class A condition was reported; 
• The asylee has applied for adjustment of status within one year of eligibility to file; and
• No evidence in the A-file or testimony given at the interview suggests that the asylee has acquired a Class A condition after his or her entry into the United States.

Even if an asylee dependent may use the result of the previous examination, he or she must still establish compliance with the vaccination requirements and submit the vaccination assessment with his or her adjustment of status application. This requirement applies even if the applicant had a vaccination assessment completed overseas by a panel physician. To comply with the requirement, the applicant must have the relevant parts of Form I-693 completed by the civil surgeon.

Afghan nationals who arrived in the United States under Operation Allies Welcome (OAW)[35] and completed an immigration medical examination abroad are not required to repeat the immigration medical examination when applying for adjustment of status if:

• The results of the immigration medical examination completed abroad are contained in the A-file and no Class A medical condition was reported;
• The immigration medical examination abroad was completed by the panel physician no more than 4 years before the date the applicant files the application for adjustment of status; and
• No evidence in the A-file or testimony given at the interview suggests that the applicant has acquired a Class A medical condition after entry into the United States.
• 
  

For children of returning residents entering the United States, as long as the parent’s visa is valid or the parent is a U.S. resident or U.S. national, there are no medical examination or vaccination requirements.

Children of returning residents entering the United States are: 

• Children born abroad after the parent has been issued an immigrant visa and while the parent is applying for admission to the United States.
• Children born abroad during the temporary visit abroad of a mother who is a national or permanent resident of the United States. 

Children 10 years of age or younger who are classified as orphans and who are applying for IR-3 and IR-4 (orphans) and IH-3 and IH-4 (Hague Convention adoptees) visas are not required to comply with the vaccination requirements before admission to the United States.[38]

🔴 Vaccinations You and Your Family Must Have to Avoid Inadmissibility In 2022, 

The required vaccinations included the ones listed below. Some of these are required only for people in certain age groups. If other diseases later become preventable by vaccines, they may be added to this list.

• Diphtheria
• Tetanus
• Pertussis
• Polio
• Measles
• Mumps
• Rubella
• Rotavirus
• Haemophilus influenzae type b (Hib)
• Hepatitis A
• Hepatitis B
• Meningococcal disease
• Varicella
• Pneumococcal disease
• Severe heart disease or Cancer, (the case officer may refuse to issue the visa), (Find-out in "important part in this page  or STL Policies)
• Influenza (flu), and COVID-19 (unlike other vaccines, the full series must be completed before the physician completes the medical exam report).

🔴 IMPORTANT NOTE:

• If you have a medical condition that causes you trouble but does not infect or harm others, such as heart disease, cancer, or certain mental illnesses, you will not be medically inadmissible. However, it is possible for you to be recognized as an ineligible public expense, that is, a person likely to need need-based government assistance (often known as welfare), if you are unable to work in the United States. And you will not be able to work, you will need health insurance and therefore you will use welfare and free government services.
• Due to this situation, heavy medical expenses will be borne by the government and the government will cover the expensive medical expenses for you.

• If you are entering the United States as a worker to work for an American company or employer, you must be in good health, and a family member may have an infectious disease, or before the visa is issued and during the medical examination. If it is determined that he has an infectious or non-infectious disease and this disease may be against the policy of the US Immigration Department or the STL company, in this case, the possibility of visa rejection for that family member. If the employer or STL company faces such an issue, it can stop the continuation of the case process for the worker's family and continue the process for the worker. If it is proven that the worker/applicant/customer already knew about this when entering into the contract and tried to hide it, he will be officially subject to the contract termination rules mentioned in the company policy under the title of lying or hiding the truth. In this case, the worker/applicant/customer is required to pay all the damages incurred to the company.