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Book outline for Policy Manual
  • Policy Manual
    • Search
    • Updates
    • Table of Contents
    • Volume 1 - General Policies and Procedures
    • Volume 2 - Nonimmigrants
    • Volume 3 - Humanitarian Protection and Parole
    • Volume 4 - Refugees and Asylees
    • Volume 5 - Adoptions
    • Volume 6 - Immigrants
    • Volume 7 - Adjustment of Status
    • Volume 8 - Admissibility
      • Part A - Admissibility Policies and Procedures
      • Part B - Health-Related Grounds of Inadmissibility
      • Part C - Civil Surgeon Designation and Revocation
        • Chapter 1 - Purpose and Background
        • Chapter 2 - Application for Civil Surgeon Designation
        • Chapter 3 - Blanket Civil Surgeon Designation
        • Chapter 4 - Termination and Revocation
        • Chapter 5 - Civil Surgeon List
      • Part D - Criminal and Related Grounds of Inadmissibility
      • Part E - Terrorism
      • Part F - National Security and Related Grounds of Inadmissibility
      • Part G - Public Charge Ground of Inadmissibility
      • Part H - Labor Certification and Select Immigrant Qualifications
      • Part I - Illegal Entrants and Other Immigration Violators
      • Part J - Fraud and Willful Misrepresentation
      • Part K - False Claim to U.S. Citizenship
      • Part L - Documentation Requirements
      • Part M - Citizenship Ineligibility
      • Part N - Noncitizens Previously Removed
      • Part O - Noncitizens Unlawfully Present
      • Part P - Noncitizens Present After Previous Immigration Violation
      • Part Q - Practicing Polygamists, International Child Abductors, Unlawful Voters, and Tax Evaders
    • Volume 9 - Waivers and Other Forms of Relief
    • Volume 10 - Employment Authorization
    • Volume 11 - Travel and Identity Documents
    • Volume 12 - Citizenship and Naturalization
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  3. Volume 8 - Admissibility
  4. Part C - Civil Surgeon Designation and Revocation
  5. Chapter 1 - Purpose and Background

Chapter 1 - Purpose and Background

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  • Resources (9)
  • Appendices (0)
  • Updates (4)
  • History (0)

A. Purpose

USCIS designates eligible physicians as civil surgeons to perform medical examinations for immigration benefit applicants in the United States. [1] 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] 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] first granted the Secretary of the Treasury the authority to examine noncitizens 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 noncitizens. [4] 

The Immigration and Nationality Act (INA) of 1952, as amended by the Homeland Security Act of 2002, [5] 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] Since USPHS medical officers are rarely available today, civil surgeons generally provide all immigration medical examinations required in the United States. 

The civil surgeon’s primary role is to perform immigration medical examinations to assess whether noncitizens 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] 

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) according to the form instructions. Applicants submit the form to USCIS as part of their 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] 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] 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] 

Civil surgeons’ responsibilities include: [11] 

  • 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] 

  • 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 accurately;

  • Informing USCIS of any changes in contact information within 15 days of the change; [13]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 Authorities

  • INA 212(a)(1) – Health-related grounds 

  • INA 232; 8 CFR 232 – Detention of aliens for physical and mental examination

  • 42 U.S.C. 252 – Medical examination of aliens

  • 42 CFR 34 – Medical examination of aliens

  • Technical Instructions for Civil Surgeons (Technical Instructions), and updates [14] 

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) and 22 CFR 42.66. See 9 FAM 302.2-3(E), Panel Physicians.

[^ 2] See INA 212(a)(1).

[^ 3] See 22 Stat. 214 (August 3, 1882).

[^ 4] See Section 8 of the Immigration Act of 1891, 26 Stat. 1084, 1085 (March 3, 1891).

[^ 5] See Pub. L. 107-296 (PDF), 116 Stat. 2135 (November 25, 2002).

[^ 6] See 8 CFR 232.2(b).

[^ 7] See INA 212(a)(1).

[^ 8] See INA 232(b) and 8 CFR 232.2(b).

[^ 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] for more information on revocation.

[^ 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.

[^ 12] Available online at cdc.gov/immigrantrefugeehealth/exams/ti/civil/technical-instructions-civil-surgeons.html. 

[^ 13] See uscis.gov/i-910 for more information on how to update contact information.

[^ 14] Available online at cdc.gov/immigrantrefugeehealth/exams/ti/civil/technical-instructions-civil-surgeons.html. 

Resources

Legal Authorities

42 CFR 34 - Medical examination of aliens

42 U.S.C. 252 - Medical examination of aliens

INA 212(a)(1) - Health-related grounds

INA 232, 8 CFR 232 - Detention of aliens for physical and mental examination

Technical Instructions for Civil Surgeons

Forms

G-28, Notice of Entry of Appearance as Attorney or Accredited Representative

I-693, Report of Medical Examination and Vaccination Record

I-910, Application for Civil Surgeon Designation

Other Materials

How to Use the USCIS Policy Manual Website (PDF, 2.99 MB)

Appendices

No appendices available at this time.

Updates

Technical Update - Replacing the Term “Alien”

May 11, 2021

This technical update replaces all instances of the term “alien” with “noncitizen” or other appropriate terms throughout the Policy Manual where possible, as used to refer to a person who meets the definition provided in INA 101(a)(3) [“any person not a citizen or national of the United States”].

Affected Sections

1 USCIS-PM - Volume 1 - General Policies and Procedures

2 USCIS-PM - Volume 2 - Nonimmigrants

6 USCIS-PM - Volume 6 - Immigrants

7 USCIS-PM - Volume 7 - Adjustment of Status

8 USCIS-PM - Volume 8 - Admissibility

9 USCIS-PM - Volume 9 - Waivers and Other Forms of Relief

10 USCIS-PM - Volume 10 - Employment Authorization

11 USCIS-PM - Volume 11 - Travel and Identity Documents

12 USCIS-PM - Volume 12 - Citizenship and Naturalization

Technical Update - Moving the Adjudicator’s Field Manual Content into the USCIS Policy Manual

May 21, 2020

U.S. Citizenship and Immigration Services (USCIS) is updating and incorporating relevant Adjudicator’s Field Manual (AFM) content into the USCIS Policy Manual. As that process is ongoing, USCIS has moved any remaining AFM content to its corresponding USCIS Policy Manual Part, in PDF format, until relevant AFM content has been properly incorporated into the USCIS Policy Manual. To the extent that a provision in the USCIS Policy Manual conflicts with remaining AFM content or Policy Memoranda, the updated information in the USCIS Policy Manual prevails. To find remaining AFM content, see the crosswalk (PDF, 350.49 KB) between the AFM and the Policy Manual.

Affected Sections

1 USCIS-PM - Volume 1 - General Policies and Procedures

2 USCIS-PM - Volume 2 - Nonimmigrants

3 USCIS-PM - Volume 3 - Humanitarian Protection and Parole

4 USCIS-PM - Volume 4 - Refugees and Asylees

5 USCIS-PM - Volume 5 - Adoptions

6 USCIS-PM - Volume 6 - Immigrants

7 USCIS-PM - Volume 7 - Adjustment of Status

8 USCIS-PM - Volume 8 - Admissibility

9 USCIS-PM - Volume 9 - Waivers and Other Forms of Relief

11 USCIS-PM - Volume 11 - Travel and Identity Documents

12 USCIS-PM - Volume 12 - Citizenship and Naturalization

Technical Update - Replacing the Term “Foreign National”

October 08, 2019

This technical update replaces all instances of the term “foreign national” with “alien” throughout the Policy Manual as used to refer to a person who meets the definition provided in INA 101(a)(3) [“any person not a citizen or national of the United States”].

Affected Sections

1 USCIS-PM - Volume 1 - General Policies and Procedures

2 USCIS-PM - Volume 2 - Nonimmigrants

6 USCIS-PM - Volume 6 - Immigrants

7 USCIS-PM - Volume 7 - Adjustment of Status

8 USCIS-PM - Volume 8 - Admissibility

9 USCIS-PM - Volume 9 - Waivers and Other Forms of Relief

10 USCIS-PM - Volume 10 - Employment Authorization

11 USCIS-PM - Volume 11 - Travel and Identity Documents

12 USCIS-PM - Volume 12 - Citizenship and Naturalization

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

January 28, 2014

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
Affected Sections

8 USCIS-PM C - Part C - Civil Surgeon Designation and Revocation

Version History

No historical versions available.

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