Chapter 3: Blanket Civil Surgeon Designation

A. Blanket Designation of State ​and​L​ocal ​H​ealth ​D​epartments​ [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 ​P​hysicians​

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​C​ertification ​R​equirements​

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 physician​’​s signature ​and​ a seal or stamp of the health department: ​

Physician ​S​ignature​

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 ​D​epartment ​S​tamp or ​S​eal​

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 form​’​s instructions.​

B. Blanket ​D​esignation of ​M​ilitary ​P​hysicians as ​C​ivil ​S​urgeons​

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. a​rmed ​f​orces and certain eligible dependents if the military physician meets certain conditions. ​

This blanket designation eases the difficulties encountered by ​U.S. a​rmed ​f​orces ​members, veterans, and certain eligible dependents ​when ​obtain​ing immigration​ medical examination​s​. 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 ​P​hysicians​

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:​

Meet the professional qualifications of a civil surgeon​ [12] As described in Chapter 1, Purpose and Background, Section C, Professional Qualifications [8 USCIS-PM C.1(C)]. except that the physician may be licensed in ​any ​state​ in the United States​, and is not required to be licensed in the state in which the physician is performing the immigration medical examination; ​

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 a​uthorized 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 need​s 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 CDC​’​s ​Technical 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 ​S​ignature​

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. a​rmed ​f​orces ​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 ​S​tamp or ​S​eal​

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 form​’​s instructions.​