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Chapter 3: Applicability of Medical Examination and Vaccination Requirement


A. Requirements by Benefit Type


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] Based on the conditions listed in INA 212(a)(1). This could apply, for example, when an officer adjudicates a request for parole.[2] See INA 212(d)(5)(A). 


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] See Matter of Arthur, 16 I&N Dec. 558 (BIA 1978) (The applicant has the burden of proof to establish his or her admissibility to the United States according to INA 291; the burden never shifts to the government). 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] Special considerations that apply to certain benefit types are noted in Section B, Special Considerations [8 USCIS-PM B.3(B)]. 


Medical Examination and Vaccination Requirements by Benefit Type

Benefit Type

Medical Examination

(Yes or No)

Vaccination

(Yes or No)

Panel Physician or 

Civil Surgeon

Immigrant Visa Applicants, applying with U.S. Department of State (DOS)

Yes

Yes

Panel Physician

Adjustment Applicants

Yes

Yes

Civil Surgeon

Nonimmigrant Visa Applicants, applying with DOS; and Nonimmigrants seeking change/extension of status while in the United States[5] See INA 248. See 8 CFR 214.1 and 8 CFR 248.

No (with some exceptions)[6] See Section B, Special Considerations [8 USCIS-PM B.3(B)].

No

N/A

Temporary Protected Status (TPS) Applicants[7] See INA 244.

No (with some exceptions)[8] See Section B, Special Considerations [8 USCIS-PM B.3(B)].

No

N/A

K or V Visa Applicants, applying with DOS[9] See INA 214. See 8 CFR 214.2(k) and 8 CFR 214.15.

Yes

No

Panel Physician

Nonimmigrant seeking change of status to V status[10] See INA 214(q) and 8 CFR 214.15. 

Yes

No

Civil Surgeon

K or V nonimmigrants applying for adjustment of status in the United States[11] See INA 245 and 8 CFR 245.

May be required[12] See Section B, Special Considerations [8 USCIS-PM B.3(B)]. 

Yes

Panel Physician and/or Civil Surgeon

Refugee Applicants, including Principal and Derivative Applicants Overseas[13] See INA 207 and 8 CFR 207.7. See INA 208 and 8 CFR 208.21.

Yes

No

Panel Physician

Applicants seeking derivative refugee or derivative asylee status while in the United States[14] See INA 207 and 8 CFR 207.

No

No

N/A

Principal Asylum Applicants in the United States[15] See INA 208 and 8 CFR 208.

No

No

N/A

Applicants Seeking Derivative Asylee Status with DOS[16] See INA 208 and 8 CFR 208.21.

Yes

No

Panel Physician

Refugee-Based Adjustment Applicants[17] See INA 209 and 8 CFR 209.1.

May be required[18] See Section B, Special Considerations [8 USCIS-PM B.3(B)]. 

Yes

Civil Surgeon[19] Including State or local health department physicians, who are blanket designated by USCIS as civil surgeons for purposes of completing the vaccination record for refugees adjusting status only.

Asylees Applying for Adjustment of Status[20] See INA 209 and 8 CFR 209.2.

May be required[21] See Section B, Special Considerations [8 USCIS-PM B.3(B)]. 

Yes

Civil Surgeon

Kurdish asylees paroled under Operation Pacific Haven applying for adjustment of status

Yes

Yes

Panel Physician or Civil Surgeon

Registry Applicants

No

No

N/A

North American Indians entering the United States[22] See 8 CFR 289.1 and 8 CFR 289.2. American Indians born in Canada who meet the regulatory requirements may be regarded as having been admitted for lawful permanent residence. Because neither an immigrant visa nor an adjustment of status application is required, the applicant is not required to comply with the medical examination and vaccination requirements.

No

No

N/A

Children of returning residents entering the United States[23] See INA 101(a)(27)(A) and 22 CFR 42.22.  or Children of U.S. nationals

No

No

N/A

Internationally Adopted Orphans[24] See INA 101(b)(1)(F), including Hague Convention Adoptees.

Yes

Yes

(Exception available)

Panel Physician


B. Special Considerations


1. Nonimmigrants and TPS Applicants


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. 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.


2. K or V Visa Applicants Applying with DOS[25] See INA 214. See 8 CFR 214.2(k) and 8 CFR 214.15. See 9 FAM 41.108 Note 1.2.


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.


3. Nonimmigrants Applying for Change of Status to V Status


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.


4. K or V Nonimmigrants Applying for Adjustment[26] See INA 245 and 8 CFR 245.


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.[27] See 8 CFR 245.5.


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.[28] See Volume 9, Waivers, Part C, Waivers for Health-Related Grounds of Inadmissibility [9 USCIS-PM C] for more information on medical waivers. 


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,[29] Under INA 214(q). 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. 


5. Refugees Applying for Adjustment[30] See INA 209 and 8 CFR 209.1.


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.[31] See 8 CFR 209.1(c). 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 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.[32] See 8 CFR 209.1(c).


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. 


6. Asylees Applying for Adjustment


All asylees are required to undergo an immigration medical exam, including vaccination assessment, at time of adjustment.[33] See 8 CFR 209.2(d).


However, according to USCIS policy developed in consultation with CDC, 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.

 

7. Children of Returning Residents Entering the United States[34] See INA 101(a)(27)(A) and 22 CFR 42.22. 


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. 


8. Internationally Adopted Orphans[35] See INA 101(b)(1)(F). See Chapter 9, Vaccination Requirement, Section G, Exceptions for Certain Adopted Children [8 USCIS-PM B.9(G)] for more on this exception.


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.[36] See INA 212(a)(1)(C), as amended by Section 2 of the International Adoption Simplification Act, Pub. L. 111-287, 124 Stat. 3058 (2010). 





Footnotes


1. [^] 

 Based on the conditions listed in INA 212(a)(1).

2. [^] 

 See INA 212(d)(5)(A).

3. [^] 

 See Matter of Arthur, 16 I&N Dec. 558 (BIA 1978) (The applicant has the burden of proof to establish his or her admissibility to the United States according to INA 291; the burden never shifts to the government).

4. [^] 

 Special considerations that apply to certain benefit types are noted in Section B, Special Considerations [8 USCIS-PM B.3(B)].

5. [^] 

 See INA 248. See 8 CFR 214.1 and 8 CFR 248.

6. [^] 

 See Section B, Special Considerations [8 USCIS-PM B.3(B)].

7. [^] 

 See INA 244.

8. [^] 

 See Section B, Special Considerations [8 USCIS-PM B.3(B)].

9. [^] 

 See INA 214. See 8 CFR 214.2(k) and 8 CFR 214.15.

10. [^] 

 See INA 214(q) and 8 CFR 214.15. 

11. [^] 

 See INA 245 and 8 CFR 245.

12. [^] 

 See Section B, Special Considerations [8 USCIS-PM B.3(B)].

13. [^] 

 See INA 207 and 8 CFR 207.7. See INA 208 and 8 CFR 208.21.

14. [^] 

 See INA 207 and 8 CFR 207.

15. [^] 

 See INA 208 and 8 CFR 208.

16. [^] 

 See INA 208 and 8 CFR 208.21.

17. [^] 

 See INA 209 and 8 CFR 209.1.

18. [^] 

 See Section B, Special Considerations [8 USCIS-PM B.3(B)].

19. [^] 

 Including State or local health department physicians, who are blanket designated by USCIS as civil surgeons for purposes of completing the vaccination record for refugees adjusting status only.

20. [^] 

 See INA 209 and 8 CFR 209.2.

21. [^] 

 See Section B, Special Considerations [8 USCIS-PM B.3(B)].

22. [^] 

 See 8 CFR 289.1 and 8 CFR 289.2. American Indians born in Canada who meet the regulatory requirements may be regarded as having been admitted for lawful permanent residence. Because neither an immigrant visa nor an adjustment of status application is required, the applicant is not required to comply with the medical examination and vaccination requirements.

23. [^] 

 See INA 101(a)(27)(A) and 22 CFR 42.22. 

24. [^] 

 See INA 101(b)(1)(F), including Hague Convention Adoptees.

25. [^] 

 See INA 214. See 8 CFR 214.2(k) and 8 CFR 214.15. See 9 FAM 41.108 Note 1.2.

26. [^] 

 See INA 245 and 8 CFR 245.

27. [^] 

 See 8 CFR 245.5.

28. [^] 

 See Volume 9, WaiversPart C, Waivers for Health-Related Grounds of Inadmissibility [9 USCIS-PM C] for more information on medical waivers.

29. [^] 

 Under INA 214(q).

30. [^] 

 See INA 209 and 8 CFR 209.1.

31. [^] 

 See 8 CFR 209.1(c).

32. [^] 

 See 8 CFR 209.1(c).

33. [^] 

 See 8 CFR 209.2(d).

34. [^] 

 See INA 101(a)(27)(A) and 22 CFR 42.22. 

35. [^] 

 See INA 101(b)(1)(F). See Chapter 9, Vaccination Requirement, Section G, Exceptions for Certain Adopted Children [8 USCIS-PM B.9(G)] for more on this exception.

36. [^] 

 See INA 212(a)(1)(C), as amended by Section 2 of the International Adoption Simplification Act, Pub. L. 111-287, 124 Stat. 3058 (2010).




Updates


Date Details
January 28, 2014
POLICY ALERT

Health-Related Grounds of Inadmissibility and Waivers

​U.S. Citizenship and Immigration Services (USCIS) is issuing guidance in the USCIS Policy Manual on the health-related grounds of inadmissibility under INA 212(a)(1) and corresponding waivers under INA 212(g).

Read more »


Current as of July 1, 2014