Presentation on theme: "Medical Exams for U.S. Bound Refugees"— Presentation transcript:
1Medical Exams for U.S. Bound Refugees Minnesota Department of Health Refugee Health Program
2Types of Medical Exams Overseas Visa Medical Examination United States Public Health ServiceDomestic Refugee Health AssessmentMinnesota Department of HealthAdjustment of Status Medical ExaminationUS Citizenship and Immigration ServicesNeeded to obtain a Green CardAdjusts status from temporary to permanent residentThe Overseas Medical Exam is overseen by the US Public Health Service with CDC training Panel Physicians around the world to perform this exam. This exam is required for entry into the United States.The domestic health screening exam is recommended but not required. Each state determines the office which coordinates this exam. This exam is done both to contain infectious diseases, but also for the refugee’s wellbeing and introduction into the US healthcare system.The Adjustment of Status exam is highly recommended for refugees who wish to adjust from a lawful temporary resident to a lawful permanent resident, a process that generates a long term work authorization or “green card.”
3Overseas Visa Medical Examination Mandatory for refugees and immigrantsCompleted by Panel Physicians trained and overseen by CDCIs exclusionary in natureResults recorded on form DS-2053, etc.
4Medical Screening for Entry into the United States “Excludable” conditions:Communicable diseases of public health significancePhysical and mental disorders with associated harmful behaviorsPsychoactive substance abuse and dependenceOther physical or mental abnormalities, disorders or disabilitiesRefugees, like immigrants, are required to receive an overseas visa medical exam one year prior to their departure to the U.S. The criteria for this examine is set forth in the Immigration and Nationality Act. The purpose of this examine is to exclude persons who have the above conditions-The quality and comprehensiveness of the visas medical examination vary. Because the examine is good for six months to one year before departure, a refugee can develop infectious conditions after the overseas medical exam and before departure to the U.S. Likewise, screening for many other infectious disease such as malaria and other intestinal parasitic infections is not routine.* Note: every immigrant regardless of their arrival category must have this screening completed in order to come to the USARefugee Health Program, Minnesota Department of Health
5Communicable Diseases of Public Health Significance Infectious tuberculosisHepatitis BHuman Immunodeficiency Viral infection (HIV)SyphilisOther Sexually Transmitted Diseases (STD) e.g. chancroid, gonorrhea, granuloma inguinale, lymphogranuloma venereumHansen’s disease (leprosy)CDC has updated screening and testing for tuberculosis at many sites to utilize current medical knowledge and best practice.10/20/08
6Quarantinable Diseases Designated by Presidential Executive Order Choleradiphtheriainfectious tuberculosisplaguesmallpoxyellow feverviral hemorrhagic feversSARSpandemic fluCDC has added a risk-based approach for aliens screened outside of the US that is based on medical and epidemiologic factors, to determine when and where additional screening, testing and treatment for specific infectious diseases should be conducted.10/20/08
7Other public health emergencies of international concern Events that are reportable as a public health emergency of international concern (PHEIC) to WHOPolioSmallpoxSARSInfluenzaOther public health emergencies of international concern10/20/08
8Types of Medical Exams Overseas Visa Medical Examination United States Public Health ServiceDomestic Refugee Health AssessmentMinnesota Department of HealthAdjustment of Status Medical ExaminationUS Citizenship and Immigration ServicesNeeded to obtain a Green CardAdjusts status from temporary to permanent residentIt is recommended that all refugees undergo a more comprehensive medical exam once they resettle in the United States. In Minnesota this process is overseen by the Refugee Health Program at the Minnesota Department of Health.
9Domestic Refugee Health Screening: Best Practices Exam w/in the first 90 days of arrivalPublic health clinics &/or private providersGoal:...to control communicable disease among, and resulting from, the arrival of new refugees through:health assessmenttreatmentreferralThe Federal Refugee Act of 1980 created a uniform system of services for refugees resettleing in the United States. Funding is available to states where refugees resettle, including dollars to state health departments to coordinate this health exam process. The process is done in partnership with resettlement agencies, state and local public health departments and private clinics.
10National Guidance on Domestic Refugee Health Screening Developed in collaboration withCenters for Disease Control, Division of Global Migration and Quarantine (DGMQ/CDC)Office of Refugee Resettlement (ORR)NIH Substance Abuse Mental Health Services Administration (SAMHSA)In 2007 the CDC, ORR and SAMHSA agreed to develop national guidelines for domestic refugee health screening. This guidance exists to help states develop best practices in their screening programs.
11Types of Medical Exams Overseas Visa Medical Examination United States Public Health ServiceDomestic Refugee Health AssessmentMinnesota Department of HealthAdjustment of Status Medical ExaminationUS Citizenship and Immigration ServicesNeeded to obtain a Green CardAdjusts status from temporary to permanent residentThis exam is part of the immigration and citizenship process and is overseen by the U.S. Citizenship and Immigration Services (USCIS).
12What is a “Green Card”?Refugees: adjusts immigration status from Lawful Temporary Resident (LTR) to Lawful Permanent Resident (LPR); provides permanent work authorization.Immigrants: permission to reside and work in the United StatesAfter immigrants and refugees have been in the United States for one year they are eligible to get a “green card” or long term work authorization. While there are many steps in this process, some of them are medical in nature. Obtaining a green card helps refugees and immigrants secure greater protection by the US government and places them on the path to citizenship.
13Adjustment of Status Exam (Green Card Exam) Civil Surgeon MUST perform the full physical exam needed for immigrants, asyleesONLY immunizations are needed for refugeesLocal public health may act as civil surgeon for refugeesfor needed information and forms
14Requirements to be a Civil Surgeon Licensed physicianFour years professional experience beyond internship and residencyGood standing with local and state medical boardsMust apply to local USCIS office (not applicable for LPH MD acting as civil surgeon)
15Refugees and Adjustment of Status No medical exam unless arrived with Class A condition, then exam is requiredVaccination requirements onlyI-693 can be signed by state or local health department officials who meet definition of civil surgeonPlace original signed I-693 in envelope, seal and give to refugeeGive copy of completed I-693 to refugee
16Immunizations for Adjustment of Status Exam NEW POLICY 2008All vaccinations recommended by the ACIP are required for everyone applying to adjust their status.