Civil Surgeons' Frequently Asked Questions (FAQ)

Frequently Asked Questions (FAQ) is a forum for common misunderstandings regarding civil surgeon matters. The following questions came to the MDH Refugee Health Program (RHP) through phone inquiries. While guidance for civil surgeons is a federal responsibility, the RHP wants to support best practices for Minnesota civil surgeons with this effort. All answers are based on responses to inquiries to Centers for Disease Control and Prevention (CDC) and U.S. Citizenship and Immigration Services (USCIS).

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Civil Surgeons' FAQ (PDF: 49KB/2 pages)
Updated 8/13

On this page:
How long is the civil surgeon signature valid on the adjustment of status medical Form I-693?
How can a civil surgeon determine whether the applicant filing for adjustment of status is a refugee?
Which parts of the new Form I-693 are refugees required to submit?
How can a civil surgeon determine which immunizations are needed?
Must a refugee who arrived with a Class A condition complete the I-693?
How does a civil surgeon know whether the refugee filing for adjustment of status arrived with a Class A condition?
Who should sign Parts 5 and 6 of Form I-693?
Is page 4 of the new Form I-693 required for refugees admitted with Class B conditions to show that they completed follow-up treatment?
Do parolees require a complete medical exam when applying for adjustment of status?
Where can I find the latest technical instructions and updates for Civil Surgeons?

How long is the civil surgeon signature valid on the adjustment of status medical Form I-693?

The medical Form I-693 has a validity period of one year (e.g., completed and signed by a civil surgeon on 1/1/2008, valid until 1/1/2009). USCIS states that all applicants filing for adjustment of status should have their medical and/or vaccination section completed as close to the submission of the I-485 as possible.

How can a civil surgeon determine whether the applicant filing for adjustment of status is a refugee?

People typically know their immigration status. This can be confirmed by looking a their I-94 card, which should indicate their refugee status with a stamp.

Which parts of the new Form I-693 are refugees required to submit?

Refugees who arrived without a Class A condition only require vaccinations with their adjustment of status; the medical examination is not required. For these refugees the entire Form I-693 should be submitted, with only the following sections completed:

Part 1: Information about you

Part 2: Section 5: Vaccinations

Part 5: Civil surgeon's certification

OR

Part 6: Health department's identifying information

How can a civil surgeon determine which immunizations are needed?

Persons applying for adjustment of status for permanent residency, including refugees, must be assessed for vaccination requirements. The required vaccines are those listed on the age-based immunization schedules recommended by the Advisory Committee for Immunization Practices (ACIP). Refer to the Technical Instructions for Vaccination for Civil Surgeons on the CDC website for specifics. Attention: Non-MDH link

Must a refugee who arrived with a Class A condition complete the I-693?

Refugees who arrived with a Class A condition are required to repeat the entire medical exam, including any necessary vaccinations. These refugees must have the entire I-693 form completed. If a refugee has a Class A condition identified after their arrival to the U.S., but before their adjustment of status, they do not need a full medical exam for the I-693.

A full medical exam is required only if the condition existed prior to arrival to the U.S. The CDC reports the chances of acquiring a new Class A condition after arrival in the U.S. are low; therefore, if a refugee was cleared for arrival to the U.S. and had no Class A condition at the time he/she was admitted, then only the vaccination requirements are necessary.

How does a civil surgeon know whether the refugee filing for adjustment of status arrived with a Class A condition?

Class A conditions require approved waivers for U.S. entry and immediate follow-up upon arrival. These conditions include:

  • Chancroid, gonorrhea, granuloma inguinate, lymphogranuloma venereum, syphilis
  • Tuberculosis (active, infectious)
  • Drug addiction
  • HIV infection
  • Hansen's disease/leprosy (infectious)
  • Mental illness with violent behavior

Civil surgeons should feel free to ask the applicant whether they arrived to the U.S. with a waivered Class A condition (refugees are issued an I-602, Waiver on Grounds of Excludability).

Who should sign Parts 5 and 6 of Form I-693?

A civil surgeon signs Part 5 of Form I-693 when he/she is reviewing vaccinations for refugees or performing the medical exam, if needed.

OR

USCIS allows physicians affiliated with public health departments to act as civil surgeons when signing the I-693 for refugees who arrived without a Class A condition. In this situation, Part 6 should be completed and signed by the public health department's physician. A stamped signature is acceptable. The stamp or seal of the public health department must be placed in Part 6. The public health department nurse or other health care professional may, but is not required to, co-sign the form.

Is page 4 of the new Form I-693 required to refugees admitted with Class B conditions to show that they completed follow-up treatment?

The CDC states that refugees who arrived with Class B conditions on their overseas medical exam are not required to submit information on Form I-693 showing that they completed their treatment. There are other mechanisms in place to ensure the refugee has followed up with treatment.

  • Under the Immigration and Nationality Act, a refugee who arrives in the U.S. with a Class B medical condition is not required to seek follow-up treatment for that condition following the initial medical exam.
  • According to CDC's Technical Instructions for the Medical Examination of Aliens in the U.S., follow-up treatment for TB after a positive TST and negative chest X-ray is only "recommended."
  • When a Class B condition is found, CDC notifies the health department where the refugee is resettling so that the health department can provide follow-up care, if needed.

Do parolees require a complete medical exam when applying for adjustment of status?

Yes, parolees require a full medical exam when applying for adjustment of status.

Where can I find the latest technical instructions and updates for Civil Surgeons?

The Technical Instructions for Civil Surgeons are available on the CDC website. Attention: Non-MDH link

Updated Wednesday, 27-Nov-2013 15:32:26 CST