I-693 Medical Exams for Permanent Residence

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All applicants for permanent residence must take a medical examination to test for certain diseases that may render the applicant ineligible absent a waiver.
 

Most applicants for US permanent residence must undergo a special medical examination. The medical exam is designed to detect communicable diseases like tuberculosis, syphilis, Hansen's disease (leprosy), HIV, AIDS and others as well as to confirm the applicant's mandatory vaccination record. Unfortunately, it is common for USCIS-approved physicians (doctors on the "civil surgeons" list) to fail to correctly complete the required report which can cause delays.

Applicants for permanent residence inside and outside of the United States are generally required to visit a USCIS-approved physician on the "civil surgeon list" for an examination and report.  The physician prepares the report using Form I-693.  USCIS maintains a list of eligible physicians inside of the United States and the US State Department maintains a list of eligible physicians in every US consular district worldwide.  Applicants may not use their own personal physician for this examination.

Upon completion of the exam, the physician provides the applicant with an executed Form I-693 in a sealed envelope.  The applicant is not supposed to open that envelope.  The sealed envelope must be submitted with the application to adjust status or for an immigrant visa.  Incredibly, many physicians will not inform the applicant if they find evidence of a communicable disease or other health problem of which the applicant was unaware.  To avoid surprises at the adjustment of status or immigrant visa interview, applicants should request a copy of form I-693 unsealed in addition to the sealed copy for USCIS or the US consulate.  Taking a copy of the I-693 report will also allow the applicant's attorney to review the form to ensure that the physician did not make any errors on the form, forget to check boxes or fill in some information (which in our experience occurs in about 20 percent of medical exam reports).


Medical Exam Facility Locator

Visit USCIS here to locate an approved doctor: https://my.uscis.gov/findadoctor


USCIS requires approved physicians to follow technical instructions provided by the US Centers for Disease Control and Prevention.  These technical instructions fall into four major areas: (1) mental health, (2) communicable diseases, and (3) vaccination history.

mental health

The Immigration and Nationality Act renders inadmissible applicants who have:

  • A current physical or mental disorder with associated harmful behavior,
  • A past physical or mental disorder with associated harmful behavior if the harmful behavior is likely to recur or to lead to other harmful behavior in the future, or
  • Suffers drug or substance abuse or addiction including abuse of or addiction to abuse of any of the substances listed in Section 202 of the Controlled Substances Act

The physician should ask question to identify physical or mental disorders including alcoholism, to identify illegal drug use, drug or other substance addiction, to determine the remission status of a previously diagnosed disorder and also to determine the likelihood of a recurrence of harmful behavior associated with a past physical or mental disorder.

Observation alone is insufficient to assess an applicant for a mental health-related diagnosis and random screening for drugs is not part of the routine medical evaluation for applicants for US residence.  The physician is required to list DSM diagnoses for mental disorders and substance-related disorders on Form I-693 under Part 2 in the Remarks for Number 3 and Number 4.

Read the CDC guidelines for immigration
mental health evaluations here

communicable and other diseases

If the applicant suffers from a communicable disease, he may be inadmissible and require a waiver before being able to qualify for permanent residence.  The reason the law refuses residence to an applicant with a communicable disease is that absent a showing that the applicant can manage the disease and reduce the likelihood of infecting others, it presents a health risk to the US population.

It is notable that Human Immunodeficiency Virus (HIV) ceased to be a ground of inadmissibility on January 4, 2010.  This means that those who test positive for HIV are not inadmissible and do not require an I-601 waiver of inadmissibility.

But applicants may be denied residence if they suffer from other types of diseases that are not communicable.  If the applicant suffers a disease that will likely require extensive medical care, prevent the person from holding a job, attending school, or engaging in other activities, this alone may be sufficient to deny the applicant US residence.

The physician is required to consider any other findings in the history or physical examination that constitute a substantial departure from normal health or well-being and must complete any diagnostic procedures necessary to determine:

  1. The likely diagnosis
  2. Whether the disorder will affect the alien’s ability to care for himself or herself, attend school, hold a job, or engage in other age-appropriate activities
  3. Whether rehabilitation or special training will be required
  4. Whether the applicant is likely to require extensive medical care or institutionalization after arrival in the United States

vaccinations

Adjustment of status applicants are required to have the following vaccinations under Immigration and Nationality Act Section 212 (8 USC 1182(a)(1):

  • Diphtheria
  • Tetanus
  • Pertussis
  • Polio
  • Measles
  • Mumps
  • Rubella
  • Rotavirus
  • Haemophilus influenzae type b
  • Hepatitis A
  • Hepatitis B
  • Meningococcal (age 11 to 18 only)
  • Varicella
  • Pneumococcal
  • Influenza (6 mos to 18 years during
    flu season and adults over 50)

At the time of this writing human papillomavirus and zoster vaccines are no longer required.

Applicants do not need to take new vaccinations if they can provide acceptable documentation of having received them in the past.  Acceptable vaccination documentation must come from a vaccination record, either a personal vaccination record or a copy of a medical chart with entries made by a physician or other authorized medical personnel.  Only those records of doses of vaccines that include the dates of receipt (month, day, and year) are acceptable.  The document must not appear to have been altered, and dates of vaccinations should seem reasonable.  Self-reported doses of vaccines without written documentation are not acceptable.

Applicants may also meet the requirements for immunity for some diseases from having actually had the disease, including: measles, mumps, rubella, varicella, hepatitis A, hepatitis B, and polio.  To meet this requirement, the physician must administer an FDA-approved test or Clinical Laboratory Improvement Amendments (CLIA)-certified kit to test for immunity.

If you are allergic to vaccinations or will likely become ill for some reason if you receive one, the physician should not make you take the vaccination.  Recognized contraindications for the administration of a vaccine include:

  • Severe (anaphylactic) allergic reaction to a vaccine component or following a prior dose of a vaccine
  • Severely immunocompromised conditions that contraindicate receiving live attenuated vaccines, notably MMR, varicella, and intranasal influenza vaccines
  • Pregnancy as a contraindication for receiving live attenuated vaccines for MMR, varicella, and intranasal influenza
  • Encephalopathy not due to another identifiable cause as a contraindication if it occurs within 7 days of pertussis vaccination.

The following conditions are not contraindications for the administration of a vaccine:

  • Mild to moderate local reactions to a previous dose of vaccine
  • Mild acute illness (e.g., low-grade fever, upper respiratory infection, diarrhea)
  • Recovering from an illness
  • Pregnancy for receiving Td, Tdap, inactivated influenza, or hepatitis B vaccine
  • Breastfeeding
  • Antimicrobial therapy
  • Tuberculin skin testing

If you are pregnant, or breastfeeding and you do not agree with CDC vaccination recommendations, or if you are uncomfortable with your inability to sue the vaccine manufacturer in the event the vaccine harms your child, it may be best to wait until your child is born and finished breastfeeding before you apply for permanent residence and take your vaccinations.  Some commentators have observed that NCVIA attempts to evade compensation, and attempts to force parents to "prove" the vaccination caused the injury (apparently by opening their own $75 million laboratory study).

waivers

An applicant who would otherwise be denied permanent residence on a health related ground may apply for a waiver.  The application is made on Form I-601.  The applicant must be the spouse, parent, unmarried son or daughter, or the minor unmarried lawfully adopted for permanent residence or the fiancee (or child of a fiancee) of a US citizen.

The appropriate authority will consider the following when deciding the application for the waiver:

  • Whether the danger to US public health that will result from admitting the applicant is minimal.  This can be shown by submitting a letter from the applicant's physician stating that his health is stable and that the applicant understands how the disease is spread and will take action to prevent spread
  • The possibility of the spreading the disease is minimal because the applicant understands how the disease is spread and will take action to prevent spread
  • Whether it is likely that a US government agency will incur an expense because of the applicants' admission, for example does the applicant have private health insurance that will pay for health care instead of relying on publicly funded care.

 

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