1. Medical Exams for U.S. Bound Refugees
Minnesota Department of Health Refugee Health Program

2. Types of Medical Exams Overseas Visa Medical Examination
United States Public Health Service
Domestic Refugee Health Assessment
Minnesota Department of Health
Adjustment of Status Medical Examination
US Citizenship and Immigration Services
Needed to obtain a Green Card
Adjusts status from temporary to permanent resident
The 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.”

3. Overseas Visa Medical Examination
Mandatory for refugees and immigrants
Completed by Panel Physicians trained and overseen by CDC
Is exclusionary in nature
Results recorded on form DS-2053, etc.

4. Medical Screening for Entry into the United States
“Excludable” conditions:
Communicable diseases of public health significance
Physical and mental disorders with associated harmful behaviors
Psychoactive substance abuse and dependence
Other physical or mental abnormalities, disorders or disabilities
Refugees, 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 USA
Refugee Health Program, Minnesota Department of Health

5. Communicable Diseases of Public Health Significance
Infectious tuberculosis
Hepatitis B
Human Immunodeficiency Viral infection (HIV)
Syphilis
Other Sexually Transmitted Diseases (STD) e.g. chancroid, gonorrhea, granuloma inguinale, lymphogranuloma venereum
Hansen’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

6. Quarantinable Diseases Designated by Presidential Executive Order
Cholera
diphtheria
infectious tuberculosis
plague
smallpox
yellow fever
viral hemorrhagic fevers
SARS
pandemic flu
CDC 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

7. Other public health emergencies of international concern
Events that are reportable as a public health emergency of international concern (PHEIC) to WHO
Polio
Smallpox
SARS
Influenza
Other public health emergencies of international concern
10/20/08

8. Types of Medical Exams Overseas Visa Medical Examination
United States Public Health Service
Domestic Refugee Health Assessment
Minnesota Department of Health
Adjustment of Status Medical Examination
US Citizenship and Immigration Services
Needed to obtain a Green Card
Adjusts status from temporary to permanent resident
It 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.

9. Domestic Refugee Health Screening: Best Practices
Exam w/in the first 90 days of arrival
Public health clinics &/or private providers
Goal:
...to control communicable disease among, and resulting from, the arrival of new refugees through:
health assessment
treatment
referral
The 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.

10. National Guidance on Domestic Refugee Health Screening
Developed in collaboration with
Centers 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.

11. Types of Medical Exams Overseas Visa Medical Examination
United States Public Health Service
Domestic Refugee Health Assessment
Minnesota Department of Health
Adjustment of Status Medical Examination
US Citizenship and Immigration Services
Needed to obtain a Green Card
Adjusts status from temporary to permanent resident
This exam is part of the immigration and citizenship process and is overseen by the U.S. Citizenship and Immigration Services (USCIS).

12. What 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 States
After 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.

13. Adjustment of Status Exam (Green Card Exam)
Civil Surgeon MUST perform the full physical exam needed for immigrants, asylees
ONLY immunizations are needed for refugees
Local public health may act as civil surgeon for refugees
for needed information and forms

14. Requirements to be a Civil Surgeon
Licensed physician
Four years professional experience beyond internship and residency
Good standing with local and state medical boards
Must apply to local USCIS office (not applicable for LPH MD acting as civil surgeon)

15. Refugees and Adjustment of Status
No medical exam unless arrived with Class A condition, then exam is required
Vaccination requirements only
I-693 can be signed by state or local health department officials who meet definition of civil surgeon
Place original signed I-693 in envelope, seal and give to refugee
Give copy of completed I-693 to refugee

16. Immunizations for Adjustment of Status Exam
NEW POLICY 2008
All vaccinations recommended by the ACIP are required for everyone applying to adjust their status.