Chapter 1 - Purpose and Background

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.