Chapter 1: Purpose and Background

A. Purpose​

U.S. Citizenship and Immigration Services (USCIS) designates eligible physicians as c​ivil surgeons to perform medical examinations for immigration benefits applicants in the ​United States​.​ [1] If a physician wishes to be designated, he or she submits an application to USCIS for designation. Civil Surgeons should be distinguished from panel physicians. Panel physicians are designated by the Department of State and provide immigration medical examinations required as part of an applicant’s visa processing at a U.S. Embassy or consulate abroad. See 42 CFR 34.2(o) and 22 CFR 42.66. See 9 FAM 42.66 and Notes. Civil surgeons assess whether applicants have any​health conditions​ that could result in exclusion from the United States. ​

B​ased on the results of the civil surgeon’s assessment, USCIS determines whether the ​applicant​ is admissible to the United States or whether the ​applicant​ is inadmissible based on health​-​related grounds of inadmissibility. The health-related grounds of inadmissibility​ [2] See INA 212(a)(1). and the medical examination of applicants are designed to protect the health of the ​United States​ population. ​

B. Background​

The Immigration Act of 1882​ [3] See 22 Stat. 58. first granted the Secretary of the Treasury the authority to examine foreign nationals arriving in the United States to prohibit the entry of any “person unable to take care of himself or herself without becoming a public charge.” ​T​he Act provided that the examination be delegated to state commissions, boards, or officers. ​

The term “civil surgeon” was first introduced in the Immigration Act of 1891 as an alternative to surgeons of the Marine Hospital Service if such surgeons were not available to perform the​medical examination on arriving aliens.​ [4] See Section 8 of the Immigration Act of 1891, 26 Stat. 1084.

The​ Immigration and Nationality Act​ (INA)​ of 1952, as amended​ by the Homeland Security Act of 2002,​ [5] See Pub. L. 107-296, 116 Stat. 2135.authorizes the Secretary of Homeland Security​to designate civil surgeons if medical officers of the U.S. Public Health Service (USPHS) are not available. USCIS exercises the authority to designate civil surgeons on the Secretary’s behalf, and may designate as many or as few civil surgeons as needed.​ [6] See 8 CFR 232.2(b). Since USPHS medical officers are rarely available today, civil surgeons generally provide all immigration medical examinations required of foreign nationals in the ​United States​. ​

The civil surgeon’s primary role is to perform immigration medical examinations to assess whether foreign nationals have any of the following​medical conditions​ that could result in their inadmissibility​:​

Communicable disease of public health significance​;​

Failure to show proof of required vaccinations (for immigrant​visa applicants and adjustment of status applicants​ only)​;​

Physical or mental disorder with associated harmful behavior​;​ and​

Drug abuse or addiction.​ [7] See INA 212(a)(1).

Civil surgeons must perform such examinations according to the ​Technical Instructions for the Medical Examination of Aliens in the United States​, ​issued by the Centers for Disease Control and Prevention (CDC), a​n agency​ of the Department of Health and Human Services (HHS).​

The civil surgeon must also record the results of the immigration medical examination on the Report of Medical Examination and Vaccination Record ​(​Form I-693​)​ according to the form instructions. A foreign national submits the​ form​ to USCIS as part of his or her immigration benefits application, if required. USCIS reviews the​ form ​to determine whether the applicant is inadmissible based on health-related grounds.​

C. Professional Qualifications​

Only ​licensed physicians​with at least ​four​ years of professional experience may be designated as civil surgeons.​ [8] See INA 232(b) and 8 CFR 232.2(b).USCIS interprets “not less than four years’ professional experience” to require four years of professional practice ​after ​completion of training. Based on consultations with CDC, USCIS has determined that internships and residences do not count toward the four-year professional experience because they are both part of a physician’s training.​ [9] A fellowship, however, would generally count toward professional experience since fellowships are not typically required as part of a physician’s training. Even if one is already licensed as a physician, the four-year period of professional practice only begins when the post-graduate training ends. ​

Therefore, to be eligible for civil surgeon designation, the physician must meet all of the following requirements: ​

Be either a Doctor of Medicine (M.D.) or a Doctor of Osteopathy (D.O.)​;​

Be licensed to practice medicine without restrictions in the state in which he or she seeks to perform immigration medical examinations​; and​

Have the requisite ​four​ years of professional experience. ​

Registered nurses, ​nurse practitioners, ​medical technicians, physical therapists, physician assistants, chiropractors, podiatrists, and other healthcare workers who are not licensed as physicians (M.D. or D.O.) may not be designated ​or function ​as civil surgeons. ​

D. Responsibilities of Designated Civil Surgeons​

Civil surgeon designation comes with a number of responsibilities. Physicians who fail to meet their responsibilities as a civil surgeon may have their designation revoked by USCIS.​ [10] See Chapter 4, Termination and Revocation [8 USCIS-PM C.4] for more information on revocation.

Civil surgeons’ responsibilities include:​ [11] See the Instructions to the Report of Medical Examination and Vaccination Record (Form I-693) and Application for Civil Surgeon Designation (Form I-910) for more information on these responsibilities.

Completing medical examinations according to ​HHS regulations and CDC ​requirements​, such as the ​Technical Instructions for the Medical Examination of Aliens in the United States (Technical Instructions)​ and any updates posted on CDC’s website;​ [12] Available online at http://www.cdc.gov/immigrantrefugeehealth/exams/ti/civil/technical-instructions-civil-surgeons.html.

Making referrals for treatment and filing case reports, as required by the T​echnical ​I​nstruction​s;​

Reporting the results of the immigration medical examination on ​Form I-693​ accurately;​

Informing USCIS of any changes in contact information within 15 days of the change;​ [13] See www.uscis.gov/i-910 for more information on how to update contact information. and​

Refraining from any activity related to the civil surgeon designation and medical examination of immigrants if USCIS revokes the physician’s civil surgeon designation. This includes the physician informing his or her patients seeking immigration medical examinations that the physician may no longer complete medical examinations. ​

E. Legal Authorit​ies​

INA 212(a)(1)​ – Health-​R​elated ​G​rounds ​

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​ [14] Available online at http://www.cdc.gov/immigrantrefugeehealth/exams/ti/civil/technical-instructions-civil-surgeons.html.