Chapter 1: Purpose and Background

A. Purpose​

The medical grounds of inadmissibility, the medical examination of foreign nationals, and the vaccinations administered to foreign nationals are designed to protect the health of the United States population. The immigration medical examination, the resulting medical examination report, and the vaccination record provide the information USCIS uses to determine if a foreign national meets the health-related standards for admissibility.​

Four basic medical conditions may make an applicant inadmissible on health-related grounds:​

Communicable disease of public health significance,​

An immigrant’s failure to show proof of required vaccinations,​

Physical or mental disorder with associated harmful behavior, and​

Drug abuse or addiction.​

B. Background​

Public health concerns have been reflected in U.S. immigration law since the Immigration Act of 1882.​ [1] See Immigration Act of 1882, 22 Stat. 214. Among others, “persons suffering from a loathsome or a dangerous contagious disease” were not allowed to enter the United States.​ [2] See Immigration Act of 1891, 26 Stat. 1084. In 1990, Congress revised and consolidated all of the grounds of inadmissibility. It narrowed health-related grounds of inadmissibility to include only applicants with communicable diseases, physical or mental disorders with associated harmful behavior, or those with drug abuse or addiction problems.​ [3] See Immigration Act of 1990 (IMMACT 90), Pub. L. 101-649.

As of 1996, Congress requires all immigrant visa and adjustment of status applicants to establish that they have been vaccinated against certain vaccine-preventable diseases.​ [4] See Illegal Immigration Reform and Immigrant Responsibility Act of 1996 (IIRIRA), Pub. L. 104-208 and INA 212(a)(1)(A)(ii).

C. Role of the Department of Health and Human Services (HHS)​

Because medical knowledge and public health concerns can and do change over time, Congress gave the Department of Health and Human Services (HHS) the authority to designate by regulations which conditions make a person inadmissible on health-related grounds. ​

The HHS component charged with defining these medical conditions is the Centers for Disease Control and Prevention (CDC). CDC’s responsibilities include:​

Publishing regulations addressing health-related conditions that render an applicant inadmissible​;​

Establishing the medical examination requirements in its Technical Instructions for Medical Examination of Aliens (Technical Instructions) that are binding on civil surgeons in the United States, panel physicians overseas, USCIS Officers, and State Department Consular Officers​;​ [5] Officers and designated physicians must obtain the Technical Instructions from CDC’s website at http://www.cdc.gov/immigrantrefugeehealth/exams/ti/index.html. Updates to the Technical Instructions must also be followed.

Responding to medical questions that officers, civil surgeons, and panel physicians may have based on the Technical Instructions​;​ [6] CDC can be reached at cdcqap@cdc.gov. Officers should identify themselves as an immigration officer in the e-mail. This e-mail address is not for inquiries from the public. It is only for inquiries from immigration officers and civil surgeons. Inquiries from the public should be submitted to CDC INFO at http://www.cdc.gov/cdc-info/requestform.html. and​

Advising USCIS on the adjudication of medical waivers.​

D. Role of the Department of Homeland Security (DHS)​

Congress authorizes the Department of Homeland Security (DHS) to determine a foreign national’s admissibility to the United States, which includes determinations based on health reasons.​ [7] See INA 212(a). DHS must follow HHS regulations and instructions when determining whether an applicant is inadmissible on health-related grounds.​ [8] See INA 212(a)(1)(A).

Congress also empowers DHS to designate qualified physicians as civil surgeons who conduct medical examinations of foreign nationals physically present in the United States.​ [9] See INA 232.

E. Making a Medical Inadmissibility Determination​

To make a medical inadmissibility determination, the officer should follow the steps outlined below: ​

Overview of Process of Making a Medical Inadmissibility Determination​

Step​ of Adjudication​

Where can I find ​
​information

​on this
s​tep? ​

Step 1:​ Is the applicant subject to health-related grounds of inadmissibility or is there another reason that requires the applicant to undergo a medical examination? ​

Chapter 3​, Applicability of Medical Examination​ and Vaccination Requirement [​8 USCIS-PM B.3​]​

Step 2:​ If required, has the applicant been medically examined by the appropriate physician and is the appropriate medical documentation in the file? ​

Chapter 3, Applicability of Medical Examination​ and Vaccination Requirement [​8 USCIS-PM B.3​]​

Step 3:​ Was the medical documentation​ [10] Report of Medical Examination and Vaccination Record (Form I-693); Medical Examination for Immigrant or Refugee Applicant (1991 TB Technical Instructions) (Form DS-2053) or the Medical Examination for Immigrant or Refugee Applicant (2007 TB Technical Instructions) (Form DS-2054), and related worksheets.properly completed and is it still valid?​

Chapter​ 4​, Review of Medical Examination Documentation [​8 USCIS-PM B.4​] through Chapter ​10​, Other Medical Conditions [​8 USCIS-PM B.10​]​

Step 4:​ Is the applicant inadmissible based on health-related grounds?​

Chapter 11​, Inadmissibility Determination [​8 USCIS-PM B.11​]​

Step 5:​ Is the applicant inadmissible based on grounds other than health-related grounds, as evidenced by the medical documentation?​

Chapter 11​, Inadmissibility Determination, Section D, Other Grounds of Inadmissibility [​8 USCIS-PM B.11(D)​]​

F. Legal Authorit​ies​

INA 212(a)(1)​ – ​Health-Related Grounds​

INA 22​1(d)​ – ​Physical Examination​

INA 232​; ​8 CFR 232​ – ​Detention of Aliens for​ Physical and​ Mental Examination​

42 U.S.C. 252​ – Medical ​E​xamination of ​A​liens​

42 CFR 34​ – Medical ​E​xamination of ​A​liens​

Technical Instructions for ​Civil Surgeons​ (Technical Instructions)​, and updates​ [11] Available online at http://www.cdc.gov/immigrantrefugeehealth/exams/ti/civil/technical-instructions-civil-surgeons.html.