INS on Medical Exams for Aliens Seeking Adjustment of Status
Purpose
The purpose of this memorandum is to provide clarification on the procedures to be followed when reviewing the results of the medical examination report, Form I-693, (Medical Examination for Aliens Seeking Adjustment of Status), submitted in support of an application for lawful permanent residence (adjustment of status under section 245 of the Immigration and Nationality Act (Act), refugee/asylee adjustment under section 209 of the Act, legalization adjustment under section 245A of the Act, and adjustment of special agricultural workers under section 210 of the Act). The medical examination instruction sheet provided by each district to the general public varies from office to office, and in many cases, contains outdated information. To ensure uniformity in the instructions provided to the general public, accompanying this memorandum is a set of medical examination instructions that should be attached to Form I-693. The names, addresses and telephone numbers of the designated civil surgeons for the particular district should be typed below the instructions.
Background
The medical examination of aliens seeking adjustment of status in the United States and the designation of civil surgeons authorized to conduct these examinations are governed by Immigration and Naturalization Service (INS) regulations at 8 CFR 234 and Department of Health and Human Services (HHS) regulations at 42 CFR, part 34. Those physicians who have been selected by the District Director to serve as designated civil surgeons are required to conduct the medical examination and report the results on Form I-693 in accordance with the Technical Instructions for the Medical Examination of Aliens in the United States, published by the Centers of Disease Control and Prevention (CDC) in June 1991. The Technical Instructions and subsequent changes were distributed to all designated civil surgeons, INS regional offices, District Directors, and Officers-in-Charge.
INS currently is in the process of revising its regulations at 8 CFR part 234, as well as the Operations Instructions, to bring them into conformity with the corresponding HHS regulations. Form I-693, which was last issued on September 1, 1987, is in the process of being revised to reflect the medical grounds of inadmissibility that were added and removed as a result of the Immigration Act of 1990, and to conform to the Technical Instructions. Until the new version of Form I-693 is issued, please note the instructions summarized below.
Discussion
When adjudicating an application for adjustment of status, examiners should carefully review Form I-693 to ensure that both the medical examination and the form have been completed according to the procedures specified in the Technical Instructions. Copies of the Technical Instructions have already been distributed to the field. If you should require an extra copy, please contact Sophia Cox, Sr. Immigration Examiner, HQADN; 202/514-5014.
Some basic guidelines:
1. The medical examination must have been performed by a civil surgeon designated by the Immigration and Naturalization Service (INS) to conduct medical examinations of aliens in the United States. If there is any question as to whether the physician who performed the medical examination is a designated civil surgeon, please contact HQADN for further clarification, before rejecting the medical examination report. If the medical examination was not performed by a designated civil surgeon, the applicant should be given a new Form I-693 and instructed to contact a designated civil surgeon.
2. The designated civil surgeon should complete Form I-693 in English. The results should be typed or printed legibly, and the form must be dated and signed by the designated civil surgeon. If Form I-693 has not been dated and signed by the civil surgeon, or if it has not been completed legibly in English, a copy must be returned to the applicant for corrective action.
3. Review Form I-693 to ensure that the designated civil surgeon has performed all the required tests -- TB, HIV, other sexually transmitted diseases, and leprosy -- and that these tests have been performed in accordance with the Technical Instructions provided by CDC. All applicants age 2 and older are required to have a tuberculin (TB) skin test. A chest x-ray is required only if the reaction to the tuberculin (TB) skin test is 5mm or greater. (See special TB instructions below.) All applicants 15 years of age and older are required to have a serologic (blood) test for syphilis and human immunodeficiency virus (HIV) infection. Applicants under the age of 15 must undergo a serologic test if there is reason to suspect infection. The scope of the required medical examination also must include a physical examination and an evaluation of the applicant's mental status in order to detect the presence and severity of Class A and Class B mental or physical disorders, and harmful behavior associated with those disorders. If the required tests or the physical examination have not been performed, a copy of Form I-693 must be returned to the applicant for the designated civil surgeon to perform the required tests and/or properly enter the results.
4. Findings of physical and mental disorders and drug abuse should be indicated in the "Remarks" section of Form I-693. If an applicant has been referred for further evaluation for a communicable disease of public health significance, physical and mental disorders with associated harmful behavior, psychoactive substance abuse or other physical or mental abnormalities, diseases or disabilities, the medical report must be accompanied by a definitive diagnosis (or a short list of likely diagnoses) and a statement as to whether the presence or absence of a Class A or Class B medical condition has been established.
Special Instructions for Examination for Tuberculosis (TB)
All applicants age 2 and older are required to have a tuberculin (TB) skill test. The designated civil surgeon may require a tuberculin (TB) skin test for a child under age 2 if there has been contact with a known TB case, or if there is any other reason to suspect TB. If the civil surgeon has performed a chest x-ray for TB, but not a skin test, the applicant should not be penalized; however, until further notified, the examiner should forward a copy of Form I-693 to CDC at the following address: Chief, Medical Screening Section, Division of Quarantine (EO3), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia 30333. CDC will then direct the designated civil surgeon to take corrective action on all future medical examinations. The District Director may revoke the designation of those civil surgeons who fail to take corrective action.
James A. Puleo
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