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Chapter 3: Blanket Civil Surgeon Designation


A. Blanket Designation of State and Local Health Departments[1] See INA 209.


1. Overview


USCIS has the authority to designate either individual physicians or members of a specified class of physicians as civil surgeons, provided they meet the legal requirements.[2] As specified under INA 232(b), 8 CFR 232.2(b), and 42 CFR 34.2(b). Through policy and in agreement with CDC, USCIS designated all State and local health departments as civil surgeons. Health departments may only use this blanket civil surgeon designation to complete the vaccination assessments for refugees seeking adjustment of status.[3] See INA 209. 


This blanket designation eases the difficulties encountered by refugee adjustment applicants in complying with the vaccination requirement. It also relieves USCIS of the need to maintain lists of health departments and the names of individual physicians at these health departments.


2. Eligible Physicians


Participation in this blanket civil surgeon designation is entirely voluntary and at the discretion of each health department. Health departments may only participate under this blanket designation if they have physicians authorized to provide medical services who meet the professional qualifications of a civil surgeon[4] As described in Chapter 1, Purpose and Background, Section C, Professional Qualifications [8 USCIS-PM C.1(C)]. since only these qualifying physicians may certify the vaccination assessment for refugees seeking adjustment of status. This includes volunteer physicians at State and local health departments. 


Eligible physicians at health departments may, but are not required to, personally perform the vaccination assessment. Nurses or other medical professionals may perform the vaccination assessment and complete the vaccination record in the Report of Medical Examination and Vaccination Record (Form I-693) as long as the health department physician reviews and certifies the Form I-693.


Neither health departments nor eligible physicians at health departments need to obtain approval from USCIS prior to performing the vaccination component of immigration medical examinations as specified in the next section. Blanket designated civil surgeons are exempt from both application and fee requirements for civil surgeon designation.


However, health departments and eligible physicians must review and be familiar with the Technical Instructions for the vaccination requirements before they can begin performing vaccination assessments.[5] The Technical Instructions are available online at: http://www.cdc.gov/immigrantrefugeehealth/exams/ti/civil/vaccination-civil-technical-instructions.html.


3. Scope


Pursuant to the understanding reached between USCIS and CDC, health departments may only use this blanket civil surgeon designation to complete the vaccination assessments for refugees seeking adjustment of status.[6] See INA 209. Therefore, health departments operating under this blanket designation should examine government-issued documents presented by the applicant to verify that he or she is a refugee.[7] Refugees may present their Arrival-Departure Record (Form I-94), Refugee Travel Document (Form I-571), or Employment Authorization Document (Form I-766) as evidence of refugee status. However, health departments completing the vaccination assessment will not know whether a refugee seeks adjustment under INA 209 or under another provision. Therefore, when reviewing a vaccination assessment completed by a blanket designated civil surgeon for a refugee seeking adjustment, the officer should confirm that the refugee is adjusting under INA 209 before accepting the vaccination assessment performed by a blanket designated health department. This blanket designation does not cover asylees seeking adjustment of status.[8] See INA 209.


Accordingly, health departments operating under this blanket designation are authorized only to perform the vaccination component of the immigration medical examination for refugees seeking adjustment of status. If a health department physician would like to perform parts of the immigration medical examination other than the vaccination assessment, the physician must obtain designation as a civil surgeon through the standard application process.[9] As outlined in Chapter 2, Application for Civil Surgeon Designation [8 USCIS-PM C.2].


Refugees who require the entire medical exam,[10] See 8 CFR 209.1(b). will likewise need to visit a physician designated as a civil surgeon through the standard application process.[11] However, blanket-designated health departments may still perform the vaccination component of the medical exam for refugees who require the entire medical exam.


4. Recording and Certification Requirements


Health departments operating under the blanket civil surgeon designation must record the vaccination assessment on the Report of Medical Examination and Vaccination Record (Form I-693) as follows: 


  • Ensure the applicant’s information and certification are completed; 

  • Complete the vaccination record; and

  • Complete the civil surgeon’s information and certification. 


In accordance with the agreements reached with CDC, health departments operating under the blanket civil surgeon designation are required to certify Form I-693 by providing the attending physicians signature and a seal or stamp of the health department: 


Physician Signature


The attending physician must sign Form I-693. A signature stamp may be used. Health department nurses or other health care professionals may, but are not required to, co-sign the form. However, a form that has been signed only by a registered nurse, physician's assistant, or other medical professional who is not a licensed physician is not sufficient.


If a form for a refugee adjusting status has been signed only by a medical professional employed by the health department (without an accompanying signature by a medical doctor), an RFE should be sent to the applicant for corrective action.


Health Department Stamp or Seal


The health department is also required to affix either the official stamp or raised seal (whichever is customarily used) of that health department on the space designated on the form.


As with all immigration medical examinations, the signed Form I-693 must be placed in a sealed envelope, according to the forms instructions. 


B. Blanket Designation of Military Physicians as Civil Surgeons 


1. Overview


Through policy, USCIS extended a blanket civil surgeon designation to military physicians for the completion of all parts of a required immigration medical examination for members and veterans of the U.S. armed forces and certain eligible dependents if the military physician meets certain conditions. 


This blanket designation eases the difficulties encountered by U.S. armed forces members, veterans, and certain eligible dependents when obtaining immigration medical examinations. It also eases the civil surgeon designation process for military physicians, since many military physicians are not licensed in the states in which they provide medical services for the military. Furthermore, this policy relieves USCIS of the need to maintain lists of individual military physicians designated as civil surgeons. 


2. Eligible Physicians


Participation in this blanket civil surgeon designation is entirely voluntary and at the discretion of each medical facility. This blanket designation only applies to military physicians who:



  • Are employed by the Department of Defense (DOD) or provides medical services to U.S. armed forces members, veterans, and their dependents as military contract providers or civilian physicians; and


  • Are authorized to provide medical services at a military treatment facility (MTF) within the United States. 


Neither the medical facility nor the physician who qualifies and wishes to participate in the blanket designation needs to obtain approval from USCIS prior to performing immigration medical examinations as specified in the next section. Blanket designated civil surgeons are exempt from both USCIS application and fee requirements for civil surgeon designation.


However, military physicians must review and be familiar with CDCTechnical Instructions for the Medical Examination of Aliens in the United States before they can begin performing immigration medical examinations.[13] The Technical Instructions are available online at: http://www.cdc.gov/immigrantrefugeehealth/exams/ti/civil/technical-instructions-civil-surgeons.html.


3. Scope


Pursuant to the understanding reached between USCIS and CDC, military physicians who qualify under this blanket civil surgeon designation may perform the entire immigration medical examination as long as the exam is conducted in the United States on the premises of an MTF, and for a U.S. armed forces member, veteran, or dependent who is eligible to receive medical care at that MTF.


Military physicians must apply for civil surgeon designation under the standard designation process[14] As outlined in Chapter 2, Application for Civil Surgeon Designation [8 USCIS-PM C.2]. if they wish to complete immigration medical examinations:


  • In a U.S. location other than on the premises of an MTF; or 

  • For applicants other than those U.S. armed forces members, veterans, or dependents to whom they are authorized to provide medical services at an MTF. 


U.S. armed forces members, veterans, or dependents will need to visit a physician designated as civil surgeon through the standard application process if they:


  • Prefer to have the immigration medical examination performed by a physician who does not qualify under this blanket designation for military physicians; 

  • Prefer to have the immigration medical examination performed in a U.S. location other than at the MTF at which they are authorized to receive medical services; or 

  • Do not have access to a military physician who is performing immigration medical examinations under this blanket designation. 


4. Recording and Certification Requirements


Military physicians operating under the blanket civil surgeon designation must record the results of the immigration medical examination on the Report of Medical Examination and Vaccination Record (Form I-693), according to the standard procedures all civil surgeons are required to follow. 


In accordance with the agreements reached with CDC, a military physician operating under the blanket civil surgeon designation is required to certify Form I-693 by providing both of the following on the form:


Physician Signature


The blanket designated civil surgeon must sign Form I-693. A signature stamp may be used. Nurses or other health care professionals may, but are not required to, co-sign the form. However, a form that has been signed only by a registered nurse, physician's assistant, or other medical professional who is not a licensed physician is not sufficient. If a form for a U.S. armed forces member, veteran, or eligible dependent has been signed only by a medical professional employed by the military facility (without an accompanying signature by a medical doctor), an RFE should be sent to the applicant for corrective action. 


MTF Stamp or Seal


The MTF is also required to affix either the official stamp or raised seal of that facility on the space designated on the form. 


The signed Form I-693 must be placed in a sealed envelope, according to the forms instructions.





Footnotes


1. [^] 

 See INA 209.

2. [^] 

 As specified under INA 232(b)8 CFR 232.2(b), and 42 CFR 34.2(b).

3. [^] 

 See INA 209.

4. [^] 

 As described in Chapter 1, Purpose and Background, Section C, Professional Qualifications [8 USCIS-PM C.1(C)].

6. [^] 

 See INA 209.

7. [^] 

 Refugees may present their Arrival-Departure Record (Form I-94), Refugee Travel Document (Form I-571), or Employment Authorization Document (Form I-766) as evidence of refugee status. However, health departments completing the vaccination assessment will not know whether a refugee seeks adjustment under INA 209 or under another provision. Therefore, when reviewing a vaccination assessment completed by a blanket designated civil surgeon for a refugee seeking adjustment, the officer should confirm that the refugee is adjusting under INA 209 before accepting the vaccination assessment performed by a blanket designated health department.

8. [^] 

 See INA 209.

9. [^] 

 As outlined in Chapter 2, Application for Civil Surgeon Designation [8 USCIS-PM C.2].

10. [^] 

 See 8 CFR 209.1(b).

11. [^] 

 However, blanket-designated health departments may still perform the vaccination component of the medical exam for refugees who require the entire medical exam.

12. [^] 

 As described in Chapter 1, Purpose and Background, Section C, Professional Qualifications [8 USCIS-PM C.1(C)].

14. [^] 

 As outlined in Chapter 2, Application for Civil Surgeon Designation [8 USCIS-PM C.2].




Updates


Date Details
January 28, 2014
POLICY ALERT

Civil Surgeon Designation and Centralization of the Designation Process at the National Benefits Center

​U.S. Citizenship and Immigration Services (USCIS) is issuing policy guidance in the USCIS Policy Manual to centralize the civil surgeon designation process at the National Benefits Center, effective March 11, 2014.

Read more »


Current as of July 1, 2014