USCIS Policy Manual

VOLUME 8: ADMISSIBILITY

PART C: CIVIL SURGEON DESIGNATION AND REVOCATION

Chapter 1: Purpose and Background


A. Purpose


U.S. Citizenship and Immigration Services (USCIS) designates eligible physicians as civil 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. 


Based 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.” The 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), an 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(http://www.uscis.gov/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. 



  • Making referrals for treatment and filing case reports, as required by the Technical Instructions;


  • Reporting the results of the immigration medical examination on Form I-693(http://www.uscis.gov/i-693) accurately;



  • 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 Authorities


  • INA 212(a)(1)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006.html#0-0-0-2301) – Health-Related Grounds 


  • INA 232(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-5339.html)8 CFR 232(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-11261/0-0-0-22375.html#0-0-0-8887a) – Detention of Aliens for Physical and Mental Examination


  • 42 U.S.C. 252(http://uscode.house.gov/view.xhtml?req=(title:42%20section:252%20edition:prelim)%20OR%20(granuleid:USC-prelim-title42-section252)&f=treesort&edition=prelim&num=0&jumpTo=true%20-%20sourcecredit%20) – Medical Examination of Aliens


  • 42 CFR 34(http://www.uscis.gov/sites/default/files/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-44228.html) – Medical Examination of Aliens



Chapter 2: Application for Civil Surgeon Designation


A. Background 


Historically, civil surgeon designation was an informal process handled by USCIS District Directors. By regulation, USCIS District Directors are authorized to designate civil surgeons in their respective jurisdictions.[15] See 8 CFR 232.2. In some circumstances, District Directors had delegated the designation authority to Field Office Directors in their districts. Physicians submitted informal written requests for civil surgeon designation to the district or field office with jurisdiction, along with documentary evidence showing they meet the professional qualifications to be a civil surgeon. 


As of March 11, 2014, USCIS replaced the informal, decentralized civil surgeon application process with a formal, centralized process by (a) requiring centralized filing of the Application for Civil Surgeon Designation (Form I-910(http://www.uscis.gov/i-910)), at a Lockbox facility, and (b) delegating the District Directors authority to grant, deny, and revoke civil surgeon designation to the Director of the National Benefits Center (NBC).[16] USCIS Field Offices continued to accept applications for civil surgeon designation until March 11, 2014. Federal regulations provide the authority for this transfer of authority: Director or district director prior to March 1, 2003, means the district director or regional service center director, unless otherwise specified. On or after March 1, 2003, pursuant to delegation from the Secretary of Homeland Security or any successive re-delegation, the terms mean, to the extent that authority has been delegated to such official: asylum office director; director, field operations; district director for interior enforcement; district director for services; field office director; service center director; or special agent in charge. The terms also mean such other official, including an official in an acting capacity, within U.S. Citizenship and Immigration Services, U.S. Customs and Border Protection, U.S. Immigration and Customs Enforcement, or other component of the Department of Homeland Security who is delegated the function or authority above for a particular geographic district, region, or area. See 8 CFR 1.2. These changes were made to improve the application intake process, enhance case management, promote consistency and uniformity in decision-making, and improve the overall efficiency and integrity of the program.


B. Application


A physician generally must apply for civil surgeon designation with USCIS. However, physicians who qualify under a blanket designation are exempt from the filing and fee requirements.[17] See Chapter 3, Blanket Civil Surgeon Designation [8 USCIS-PM C.3] for more information. 


USCIS will only accept[18] USCIS also has the authority to select as many (or as few) civil surgeons necessary to serve the needs of the jurisdiction. See 8 CFR 232.2(b). Therefore, USCIS may also reject complete applications if it determines the jurisdiction’s needs are met. In this case, USCIS would return the entire application package to the physician, including the fee associated with the application.  and consider complete applications for civil surgeon designation; applications must be submitted in accordance with the form instructions.[19] Filing instructions can be found at www.uscis.gov/I-910. 


A complete application consists of the following: 


1. Application for Civil Surgeon Designation (Form I-910(http://www.uscis.gov/i-910))


A physician seeking designation as a civil surgeon must complete all required parts of the Application for Civil Surgeon Designation.[20] The current version of the form and instructions can be accessed online at www.uscis.gov/i-910. 


2. Filing Fee


The physician must include the required filing fee[21] See 8 CFR 103.7(b)(1)(i). The current filing fee can also be found at www.uscis.gov/i-910.  with the completed Application for Civil Surgeon Designation. Applications for civil surgeon designation that do not include the correct filing fee will be rejected.

3. Evidence


The physician must include evidence that shows that he or she meets the eligibility requirements to be designated a civil surgeon. At a minimum, the civil surgeon applicant must submit all of the following evidence with the completed Application for Civil Surgeon Designation (Form I-910(http://www.uscis.gov/i-910)):[22] If not all of the required initial evidence has been submitted or the officer determines that the totality of the evidence submitted does not meet the applicable standard of proof, the officer may request additional evidence.


  • Proof of U.S. citizenship, legal status, or authorization to work in the United States; 


  • A copy of the physician’s current medical license in the state in which he or she seeks to perform immigration medical examinations; 


  • A copy of the physician’s medical degree verifying he or she is an M.D. or D.O.; and


  • Evidence to verify the requisite professional experience, such as letters of employment verification.

4. Signature


The physician must sign the application.[23] See 8 CFR 103.2(a)(2). The signature must be submitted to USCIS on Application for Civil Surgeon Designation (Form I-910(http://www.uscis.gov/i-910))Applications for civil surgeon designation that do not include a signature may be rejected or returned to the physician. 


C. Adjudication of Civil Surgeon Applications


1. Adjudication


To determine whether to approve or deny the application for civil surgeon designation, the officer should follow these steps:


Adjudication of Civil Surgeon Applications

Step 1: Determine whether the physician meets all of the eligibility requirements to be designated a civil surgeon:



  • Is the physician an M.D. or a D.O?


  • Is the physician licensed without restriction in the state in which he or she seeks to perform immigration medical examinations? 


  • Does the physician have at least four years of professional experience, not including residency or internships or other experience related to training?


If there is insufficient information in the application and evidence submitted with the application to make this determination, the officer may issue a Request for Evidence (RFE) for additional information such as documentary evidence establishing any of the eligibility requirements. 


If the physician does not meet all of the eligibility requirements, the officer should deny the application. Otherwise, go to Step 2.


Step 2: Determine whether the application warrants a favorable exercise of discretion.[25] USCIS has the discretion to designate as many (or as few) civil surgeons as needed. See 8 CFR 232.2(b). In general, a favorable exercise of discretion is warranted unless there are adverse factors that prevent it.


An unfavorable exercise of discretion may, for instance, be applied to any applications submitted by physicians who had a prior civil surgeon designation revoked by USCIS, and where the concerns underlying that revocation have not been resolved.


If there is insufficient evidence in the application to make this determination, the officer may request additional information through the issuance of a Request for Evidence (RFE).

Examples:


Example: The physician had a prior civil surgeon designation revoked due to the physician’s confirmed participation in an immigration fraud scheme. The officer should deny the civil surgeon application as a matter of discretion. The fee will not be refunded since USCIS performed an adjudication of the application.


Example: The physician had a prior civil surgeon designation revoked due to suspension of her medical license. However, the officer determines that the underlying reason for the suspension has been resolved, is unlikely to recur, and the physician now has a current, unrestricted medical license. In this case, the officer may approve the civil surgeon application if the physician otherwise meets the eligibility requirements.



2. Approval


If the application for civil surgeon designation is approved, the officer should do the following: 


Notification


Notify the physician in writing of the approval.


Files


Either create a new file for the physician who was granted civil surgeon designation; or, if a file for the physician already exists, update the file to reflect the grant of designation. 


The files should be maintained in such a way as to facilitate retrieval or review of information relating to the specific civil surgeon. The file should be retained according to the established records retention schedule. 

Updating Civil Surgeon List


The NBC should coordinate with Customer Service and Public Engagement Directorate (CSPE) to ensure the civil surgeon list is updated in a timely manner to reflect all newly designated civil surgeons. At a minimum, the newly designated civil surgeons full name, name of medical practice, address, and telephone number should be added to the list. Particular care should be taken when entering the civil surgeons zip code and telephone number since these are the primary ways that applicants search for civil surgeons.


3. Denial


If the application for civil surgeon designation is denied, the officer should do the following: 


Notification


Notify the physician in writing of the denial. There is no appeal from a decision denying designation as a civil surgeon. However, the physician may file a motion to reopen or reconsider.[26] See 8 CFR 103.5. To file a motion to reopen or reconsider, a physician should file a Notice of Appeal or Motion (Form I-290B), with fee. Forms and fee information can be found at www.uscis.gov.  In the decision denying designation as a civil surgeon, the officer must notify the physician of the possibility to file a timely motion to reopen or reconsider. 


A physician who is denied designation is not precluded from reapplying for civil surgeon designation. In the decision denying designation as a civil surgeon, the officer should also notify the physician that he or she may reapply if the physician believes that he or she has overcome the reason(s) for denial.[27] If the physician would like to reapply for civil surgeon designation because he or she has overcome the reason(s) for denial, the physician must file a new Application for Civil Surgeon Designation (Form I-910) with the required evidence and filing fee. 


Files


Create a new file for each physician who was denied designation; or, if a file for the physician already exists, the officer should update the file to reflect the denial of the designation. 


4. File Maintenance


The files should be maintained in such a way as to facilitate retrieval or review of information relating to the specific civil surgeon. The file should be retained according to the established records retention schedule.


Chapter 3: Blanket Civil Surgeon Designation


A. Blanket Designation of State and Local Health Departments[28] 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.[29] 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.[30] 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[31] 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(http://www.uscis.gov/i-693)) as long as the health department physician reviews and certifies the Form I-693(http://www.uscis.gov/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.[32] 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.[33] 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.[34] 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.[35] 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.[36] As outlined in Chapter 2, Application for Civil Surgeon Designation [8 USCIS-PM C.2].


Refugees who require the entire medical exam,[37] See 8 CFR 209.1(b). will likewise need to visit a physician designated as a civil surgeon through the standard application process.[38] 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(http://www.uscis.gov/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(http://www.uscis.gov/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(http://www.uscis.gov/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(http://www.uscis.gov/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.[40] 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[41] 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(http://www.uscis.gov/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(http://www.uscis.gov/i-693) by providing both of the following on the form:


Physician Signature


The blanket designated civil surgeon must sign Form I-693(http://www.uscis.gov/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(http://www.uscis.gov/i-693) must be placed in a sealed envelope, according to the forms instructions.


Chapter 4: Termination and Revocation


A. Voluntary Termination


civil surgeon who no longer wishes to be designated as civil surgeon should request, in writing, that USCIS terminate the designation.[42] See www.uscis.gov/i-910 for more information on where to send a request to terminate one’s designation. 


A physician who voluntarily terminates his or her civil surgeon designation must re-apply with USCIS if he or she wishes to be designated as a civil surgeon again.


B. Revocation


Current regulations do not contain specific revocation provisions; however, the law does not preclude revocation, especially when the physician no longer qualifies for civil surgeon designation.


1. Grounds for Revocation


USCIS may revoke a physician’s civil surgeon designation if he or she:


  • Fails to comply with the Technical Instructions, Form I-693(http://www.uscis.gov/i-693) Instructions, or fails to fulfill other responsibilities of a civil surgeon consistently or intentionally;


  • Falsifies or conceals any material fact in the application for civil surgeon designation, or provides any false documents or information to obtain the designation;


  • Knowingly falsifies or conceals any material fact on Form I-693(http://www.uscis.gov/i-693), or includes any false documents or information to support any findings in the record;


  • Fails to maintain a currently valid and unrestricted license to practice as a physician in any state in which the physician conducts immigration medical examinations, unless otherwise excepted or exempted from this requirement;


  • Is subject to any court or disciplinary action that revokes, suspends, or otherwise restricts the physician’s authority to practice as a physician in any state in which the physician conducts immigration medical examinations; or 


  • Has failed to meet any of the professional qualifications for a civil surgeon at any time during the period of a physician’s designation as a civil surgeon, unless USCIS finds both that the physician has corrected any gap in eligibility and that the physician refrained from conducting immigration medical examinations during any period in which the physician was not eligible for designation as a civil surgeon. 


2. Initiating Revocation


The file should be well-documented before USCIS takes any steps to revoke a physician’s civil surgeon designation. When the proposed revocation is based on allegations of misconduct reported by an adjustment of status applicant, the officer should take a sworn statement to support the allegations. The officer should also retain any other available evidence of the alleged misconduct. 


The NBC may request the assistance of other USCIS offices to collect evidence if such evidence is not otherwise available to the NBC and if resources allow. For instance, if the NBC is unable to reach or communicate with a particular civil surgeon, the NBC may request assistance from the local office to contact the civil surgeon.


In instances where the civil surgeon may be involved in fraud, USCIS Fraud Detection and National Security Directorate (FDNS) should be notified per the standard fraud referral operating procedures and the civil surgeon’s record should be annotated to reflect that suspected fraud played a factor in initiating revocation. Depending on the nature and severity of the allegations, it may also be necessary to consult with CDC to obtain expert medical advice.


USCIS counsel must review any proposed revocation, unless the intended revocation is based on evidence that the civil surgeon is no longer licensed to practice medicine in the state where he or she is performing immigration medical examinations. When referring the case to USCIS counsel, the officer should include the reasons for the intended revocation and copies of the supporting evidence. 


Once the decision has been made to initiate the revocation, the officer must serve the physician with a notice of intent to revoke by Certified Mail/Return Receipt Requested or other method that provides proof of delivery. The notice must clearly state the exact grounds for the intended revocation and include copies of any relevant evidence.[43] USCIS may redact certain sensitive or identifying information. The officer must give the physician 30 days from the date of the notice to respond with countervailing evidence. The physician may be represented by private counsel at his or her own expense.[44] Notice of Entry of Appearance as Attorney or Accredited Representative (Form G-28) must also be filed in this case. 


3. Allegations of Malpractice, Breaches of Medical Ethics, and Other Improper Conduct


The authority to designate civil surgeons does not give USCIS authority to regulate the practice of medicine. For this reason, the process for revoking designation as a civil surgeon is not the proper forum for adjudicating complaints against a physician concerning malpractice, breach of medical ethics, or other improper conduct. If USCIS receives a complaint of this kind, USCIS should advise the complainant to make the complaint with the proper medical licensing authority for the State or territory in which the physician practices. 


4. Decision


Once the period for the physician’s response to the notice of intent to revoke has expired, USCIS will review the record and decide whether to revoke the physician’s designation as a civil surgeon. Any response from the physician will be included in the record of proceeding. USCIS must notify the physician in writing of the decision. 


There is no administrative appeal from a decision to revoke a physicians designation as a civil surgeon. The physician may, however, file a motion to reopen or reconsider.[45] As permitted in 8 CFR 103.5. To file a motion to reopen or reconsider, a physician should file a Notice of Appeal or Motion (Form I-290B), with fee. Forms and fee information can be found at www.uscis.gov.  A decision revoking a physicians designation as a civil surgeon must notify the physician of the right to file a timely motion to reopen or reconsider.


Similarly, USCIS may reopen and reconsider a decision on its own motion. A physician whose civil surgeon designation is revoked is not precluded from reapplying for civil surgeon designation, but the ground(s) upon which revocation is based should be considered as part of the adjudication of a subsequent application for civil surgeon designation. A physician, however, whose prior civil surgeon designation was revoked based on confirmed involvement in an immigration benefits fraud scheme will be denied civil surgeon designation upon reapplication. 


If USCIS revokes a physician’s designation as a civil surgeon, the public civil surgeon list should be updated immediately to remove the civil surgeons information.[46] As specified in Chapter 5, Civil Surgeon List [8 USCIS-PM C.5].


If an officer reviewing Form I-693(http://www.uscis.gov/i-693) has a concern about the sufficiency of an immigration medical examination performed by a physician who was designated at the time of the medical exam but subsequently had his or her designation revoked, the officer may reorder the medical exam to be performed by a civil surgeon to address the concern.[47] In general, an officer may order or reorder an immigration medical examination, in part or in whole, at any time if he or she has concerns regarding an applicant’s inadmissibility on health-related grounds. See Volume 8, Admissibility, Part B, Health-Related Grounds of Inadmissibility [8 USCIS-PM B]. 


Chapter 5: Civil Surgeon List


A. Overview


USCIS maintains a nationwide list of civil surgeons available to the public. Applicants may search the list for civil surgeons designated in their area at USCIS.gov (via the Civil Surgeon Locator) or through the National Customer Service Center’s toll-free number at 1-800-375-5283. 


Physicians on the civil surgeon list are generally current in their designation as civil surgeons. Since the list is updated weekly, it is advisable for the applicants to check that a physician is still on the civil surgeon list as close as possible to the date of the immigration medical exam appointment. If uncertain, applicants should also confirm with their doctors regarding their civil surgeon status prior to the immigration medical examination.


B. Requests to Update the Civil Surgeon Information


A civil surgeon should inform USCIS of any change that is relevant to the civil surgeon designation within 15 days of the change.[48] See www.uscis.gov/i-910 for more information on how to update contact information.


If an officer at a USCIS field or district office receives a request to update the civil surgeon list, he or she should forward the request to the NBC for review. 


C. Maintaining the Civil Surgeon List


USCIS will review all requests from civil surgeons to update contact information or to terminate the civil surgeon designation. USCIS will also update the civil surgeon list accordingly, as well as remove civil surgeons whose designations have been suspended or revoked. 


1. Request to Update Contact Information


If a civil surgeon’s request to update contact information involves a move to a new state, then evidence of medical licensure in the new state[49] The physician must show that he or she continues to meet the professional qualifications to be a civil surgeon in the new state. must accompany the request before the officer may approve it. If this evidence is missing, the officer may request this information through the issuance of an RFE


2. Termination, Suspension, or Revocation


If a civil surgeon requests to be removed from the civil surgeon list or if USCIS determines designation should be suspended or revoked, the officer should annotate the date and reason for removal. Records of former civil surgeons should be retained internally; the information may be relevant, for instance, to the adjudication of a medical examination the civil surgeon completed before he or she was removed from the civil surgeon list or if the physician re-applies for civil surgeon designation in the future.


3. Updates and Review of Civil Surgeon List


USCIS will ensure the civil surgeon list is updated in a timely manner to reflect any changes in a civil surgeon’s contact information or designation status. In addition, USCIS will perform a review of the civil surgeon list on a bi-annual basis, at a minimum, to ensure that all publicly available civil surgeon information is current and accurate.


If during this review USCIS learns that a civil surgeon is no longer performing immigration medical examinations in the location specified as part of the designation, or is no longer practicing medicine at all, USCIS may terminate the civil surgeon designation and remove the physician from the list. USCIS should follow regular revocation procedures.





Footnotes


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)(http://www.uscis.gov/sites/default/files/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-44228.html) and 22 CFR 42.66. See 9 FAM 42.66 and Notes.

2. [^] 

 See INA 212(a)(1)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006.html#0-0-0-2301).

3. [^] 

 See 22 Stat. 58.

4. [^] 

 See Section 8 of the Immigration Act of 1891, 26 Stat. 1084.

5. [^] 

 See Pub. L. 107-296, 116 Stat. 2135.

6. [^] 

 See 8 CFR 232.2(b)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-11261/0-0-0-22375/0-0-0-22384.html#0-0-0-14915).

7. [^] 

 See INA 212(a)(1)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006.html#0-0-0-2301).

8. [^] 

 See INA 232(b)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-5339.html#0-0-0-4235) and 8 CFR 232.2(b)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-11261/0-0-0-22375/0-0-0-22384.html#0-0-0-14915).

9. [^] 

 A fellowship, however, would generally count toward professional experience since fellowships are not typically required as part of a physician’s training.

10. [^] 

 See Chapter 4, Termination and Revocation [8 USCIS-PM C.4(http://www.uscis.gov/policymanual/HTML/PolicyManual-Volume8-PartC-Chapter4.html)] for more information on revocation.

11. [^] 

 See the Instructions to the Report of Medical Examination and Vaccination Record (Form I-693(http://www.uscis.gov/i-693)) and Application for Civil Surgeon Designation (Form I-910(http://www.uscis.gov/i-9)) for more information on these responsibilities.

12. [^] 

 Available online at http://www.cdc.gov/immigrantrefugeehealth/exams/ti/civil/technical-instructions-civil-surgeons.html(http://www.cdc.gov/immigrantrefugeehealth/exams/ti/civil/technical-instructions-civil-surgeons.html)

13. [^] 

 See www.uscis.gov/i-910(http://www.uscis.gov/i-910) for more information on how to update contact information.

14. [^] 

 Available online at http://www.cdc.gov/immigrantrefugeehealth/exams/ti/civil/technical-instructions-civil-surgeons.html(http://www.cdc.gov/immigrantrefugeehealth/exams/ti/civil/technical-instructions-civil-surgeons.html)

15. [^] 

 See 8 CFR 232.2(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-11261/0-0-0-22375/0-0-0-22384.html#0-0-0-14909). In some circumstances, District Directors had delegated the designation authority to Field Office Directors in their districts.

16. [^] 

 USCIS Field Offices continued to accept applications for civil surgeon designation until March 11, 2014. Federal regulations provide the authority for this transfer of authority: Director or district director prior to March 1, 2003, means the district director or regional service center director, unless otherwise specified. On or after March 1, 2003, pursuant to delegation from the Secretary of Homeland Security or any successive re-delegation, the terms mean, to the extent that authority has been delegated to such official: asylum office director; director, field operations; district director for interior enforcement; district director for services; field office director; service center director; or special agent in charge. The terms also mean such other official, including an official in an acting capacity, within U.S. Citizenship and Immigration Services, U.S. Customs and Border Protection, U.S. Immigration and Customs Enforcement, or other component of the Department of Homeland Security who is delegated the function or authority above for a particular geographic district, region, or area. See 8 CFR 1.2(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-11261/0-0-0-11287.html#0-0-0-8829a).

17. [^] 

 See Chapter 3, Blanket Civil Surgeon Designation [8 USCIS-PM C.3(http://www.uscis.gov/policymanual/HTML/PolicyManual-Volume8-PartC-Chapter3.html)] for more information.

18. [^] 

 USCIS also has the authority to select as many (or as few) civil surgeons necessary to serve the needs of the jurisdiction. See 8 CFR 232.2(b)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-11261/0-0-0-22375/0-0-0-22384.html#0-0-0-14915). Therefore, USCIS may also reject complete applications if it determines the jurisdiction’s needs are met. In this case, USCIS would return the entire application package to the physician, including the fee associated with the application. 

19. [^] 

 Filing instructions can be found at www.uscis.gov/I-910(http://www.uscis.gov/I-910)

20. [^] 

 The current version of the form and instructions can be accessed online at www.uscis.gov/i-910(http://www.uscis.gov/i-910). 

21. [^] 

 See 8 CFR 103.7(b)(1)(i)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-11261/0-0-0-11630.html#0-0-0-8845a). The current filing fee can also be found at www.uscis.gov/i-910(http://www.uscis.gov/i-910)

22. [^] 

 If not all of the required initial evidence has been submitted or the officer determines that the totality of the evidence submitted does not meet the applicable standard of proof, the officer may request additional evidence.

23. [^] 

 See 8 CFR 103.2(a)(2)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-11261/0-0-0-11630/0-0-0-11646.html#0-0-0-9429).

24. [^] 

 If an officer grants civil surgeon designation to a physician who is only authorized to work in the United States for a limited period of time, the designation should be limited to the duration of the physician’s work authorization. 

25. [^] 

 USCIS has the discretion to designate as many (or as few) civil surgeons as needed. See 8 CFR 232.2(b)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-11261/0-0-0-22375/0-0-0-22384.html#0-0-0-14915).

26. [^] 

 See 8 CFR 103.5(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-11261/0-0-0-11630/0-0-0-11907.html#0-0-0-9357). To file a motion to reopen or reconsider, a physician should file a Notice of Appeal or Motion (Form I-290B(http://www.uscis.gov/i-290b)), with fee. Forms and fee information can be found at www.uscis.gov(http://www.uscis.gov)

27. [^] 

 If the physician would like to reapply for civil surgeon designation because he or she has overcome the reason(s) for denial, the physician must file a new Application for Civil Surgeon Designation (Form I-910(http://www.uscis.gov/i-9)with the required evidence and filing fee. 

28. [^] 

 See INA 209(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-1825.html).

29. [^] 

 As specified under INA 232(b)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-5339.html#0-0-0-4235)8 CFR 232.2(b)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-11261/0-0-0-22375/0-0-0-22384.html#0-0-0-14915), and 42 CFR 34.2(b)(http://www.uscis.gov/sites/default/files/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-44228.html).

30. [^] 

 See INA 209(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-1825.html).

31. [^] 

 As described in Chapter 1, Purpose and Background, Section C, Professional Qualifications [8 USCIS-PM C.1(C)(http://www.uscis.gov/policymanual/HTML/PolicyManual-Volume8-PartC-Chapter1.html#S-C)].

32. [^] 

 The Technical Instructions are available online at: http://www.cdc.gov/immigrantrefugeehealth/exams/ti/civil/vaccination-civil-technical-instructions.html(http://www.cdc.gov/immigrantrefugeehealth/exams/ti/civil/vaccination-civil-technical-instructions.html).

33. [^] 

 See INA 209(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-1825.html).

34. [^] 

 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(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-1825.html) 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(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-1825.html) before accepting the vaccination assessment performed by a blanket designated health department.

35. [^] 

 See INA 209(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-1825.html).

36. [^] 

 As outlined in Chapter 2, Application for Civil Surgeon Designation [8 USCIS-PM C.2(http://www.uscis.gov/policymanual/HTML/PolicyManual-Volume8-PartC-Chapter2.html)].

37. [^] 

 See 8 CFR 209.1(b)(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-11261/0-0-0-15524/0-0-0-15531.html#0-0-0-11779).

38. [^] 

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

39. [^] 

 As described in Chapter 1, Purpose and Background, Section C, Professional Qualifications [8 USCIS-PM C.1(C)(http://www.uscis.gov/policymanual/HTML/PolicyManual-Volume8-PartC-Chapter1.html#S-C)].

40. [^] 

 The Technical Instructions are available online at: http://www.cdc.gov/immigrantrefugeehealth/exams/ti/civil/technical-instructions-civil-surgeons.html(http://www.cdc.gov/immigrantrefugeehealth/exams/ti/civil/technical-instructions-civil-surgeons.html).


41. [^] 

 As outlined in Chapter 2, Application for Civil Surgeon Designation [8 USCIS-PM C.2(http://www.uscis.gov/policymanual/HTML/PolicyManual-Volume8-PartC-Chapter2.html)].

42. [^] 

 See www.uscis.gov/i-910(http://www.uscis.gov/i-910) for more information on where to send a request to terminate one’s designation.

43. [^] 

 USCIS may redact certain sensitive or identifying information.

44. [^] 

 Notice of Entry of Appearance as Attorney or Accredited Representative (Form G-28(http://www.uscis.gov/g-28)must also be filed in this case.

45. [^] 

 As permitted in 8 CFR 103.5(http://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-11261/0-0-0-11630/0-0-0-11907.html#0-0-0-9357). To file a motion to reopen or reconsider, a physician should file a Notice of Appeal or Motion (Form I-290B(http://www.uscis.gov/i-290b)), with fee. Forms and fee information can be found at www.uscis.gov(http://www.uscis.gov). 

46. [^] 

 As specified in Chapter 5, Civil Surgeon List [8 USCIS-PM C.5(http://www.uscis.gov/policymanual/HTML/PolicyManual-Volume8-PartC-Chapter5.html)].

47. [^] 

 In general, an officer may order or reorder an immigration medical examination, in part or in whole, at any time if he or she has concerns regarding an applicant’s inadmissibility on health-related grounds. See Volume 8, Admissibility, Part B, Health-Related Grounds of Inadmissibility [8 USCIS-PM B(http://www.uscis.gov/policymanual/HTML/PolicyManual-Volume8-PartB.html)].

48. [^] 

 See www.uscis.gov/i-910(http://www.uscis.gov/i-910) for more information on how to update contact information.

49. [^] 

 The physician must show that he or she continues to meet the professional qualifications to be a civil surgeon in the new state.