Before Arrival in the United States
The Immigration and Nationality Act (INA), which relates to the immigration, temporary admission, naturalization, and removal of foreigners, mandates that all immigrants and refugees migrating to the United States undergo an overseas medical screening examination performed by panel physicians.
A panel physician is a medically trained, licensed, and experienced medical doctor practicing overseas who is appointed by the local US embassy or consulate. More than 760 panel physicians perform overseas pre-departure medical examinations in accordance with requirements, referred to as technical instructions, provided by CDC.
Medical examinations performed by non-authorized physicians will not be accepted.
Under U.S. immigration law, ALL applicants for immigrant visas are required to undergo and complete a medical examination, regardless of age. The medical examination findings by a panel physician are binding on the consular officer and used to determine eligibility to receive a visa.
The medical examination includes a review of the applicant's medical history, physical examination, chest X-ray, and blood tests. The physical examination will at least include examination of the eyes, ears, nose and throat, extremities, heart lungs, abdomen, lymph, nodes, skin, and external genitalia.
The mandated medical examination focuses primarily on detecting diseases determined to be inadmissible conditions for the purposes of visa eligibility and on preventing the importation of diseases of public health importance. These medical conditions include infectious diseases such as TB, Hansen disease, and sexually transmitted diseases; mental disorders associated with harmful behavior; and substance abuse or addiction.
Note: As of January 4, 2010, testing for HIV is no longer a required part of the US immigration medical screening process, and HIV infection is no longer an inadmissible condition that prevents non-US citizens from entering the United States.
The visit to the panel physician also provides an opportunity to give preventive medical interventions, such as updating vaccines and administering presumptive therapy for parasitic or other infectious diseases that may be affecting a specific refugee population at the time of migration, including nematode infections, malaria, and specific vaccine-preventable diseases.
Important Notice: Immigrant visa applicants should complete their medical examinations with authorized physicians before their scheduled interview dates. If you complete your medical examination after your visa interview, processing of your immigrant visa case will be delayed until the U.S. Embassy or Consulate has received your medical examination results. Therefore, applicants are strongly encouraged to complete their medical exams prior to their visa interviews.
Classification of Applicants
To determine the inadmissibility of an applicant, medical conditions are categorized as class A or B. Class A conditions are defined as those that preclude an immigrant or refugee from entering the United States. Class B conditions are defined as physical or mental abnormalities, diseases, or disabilities serious enough or permanent in nature, as to amount to a substantial departure from normal well-being. Follow-up evaluation soon after US arrival is recommended for immigrants or refugees with class B TB. If an immigrant or refugee has an inadmissible condition, a visa may still be issued after the illness has been adequately treated or after a waiver of the visa ineligibility has been approved by the Citizenship and Immigration Services.
The approximate medical examination fee is US$200.00 for adults (15 years of age or older) and US$185.00 for children (14 years of age or younger). There may be additional costs for each repeat X-ray. In most cases, local US embassy or consulate will provide instructions on where and how to pay fees. Prevailing exchange rates will apply for each country.
A chest X-ray is not required for children below 15 years old, unless symptoms of tuberculosis (TB) exist, there is a history of TB, or there has been possible exposure of TB with a known case such as a family or household member with TB.
The U.S. Public Health Service/Centers for Disease Control (USPHS/CDC) mandates women who are pregnant to have chest X-ray examinations conducted. Chest X-rays for pregnant women are not dangerous if taken with the proper shielding. Applicants who have previous chest X-rays must bring the results with them to SLMCEC for comparative analysis.
Vaccination Requirements and Proof of Vaccinations
In 199, a subsection was added to the INA requiring that people seeking immigrant visas for permanent residency show proof of receipt of at least 1 dose of all vaccination series recommended by the Advisory Committee on Immunization Practices (ACIP). As of December 14, 2009, CDC adopted revised vaccination criteria to determine which vaccines recommended by ACIP should be required for immigrant visa applicants. These criteria allow CDC the flexibility to adapt vaccination requirements based on public health needs. The new vaccination criteria state that the vaccine must:
- be age-appropriate
- protect against a disease that has the potential to cause an outbreak
- protect against a disease that has been eliminated or is in the process of being eliminated in the United States
These regulations apply to all adult immigrants and most immigrant children. However, internationally adopted children who are under 10 years of age may obtain a waiver of exemption from the immunization requirements. Adoptive parents are required to sign a waiver indicating their intention to comply with the immunization requirements within 30 days of the infant’s or child’s arrival in the United States. Refugees are not required to meet the INA immunization requirements at the time of entry into the United States but must show proof of vaccination at the time they apply for permanent US residence, typically 1 year after arrival.
U.S. immigration law requires that ALL immigrant visa applicants be vaccinated against certain vaccine-preventable diseases before they can be admitted to the United States for permanent residence.
Vaccinations currently required are as follows:
- Haemophilus influenzae Type B
- Hepatitis A
- Hepatitis B
- Meningococcal disease
- Any other vaccinations recommended by the Centers for Disease Control (CDC) and Advisory Committee for Immunization Practices.
Note: On December 14, 2009, the 2009 Technical Instructions for Panel Physicians for Vaccinations had replaced the 2007 Vaccination Technical Instructions for Panel Physicians.
Bring Your Vaccination Records for the Panel Physician’s Review
You should bring records to show that you have already received vaccination against certain vaccine-preventable diseases. The panel physician will review the vaccination records and will determine if you meet the vaccination requirement. Only the panel physician can determine which vaccinations are medically appropriate. This could mean that you may be required to repeat doses of vaccines that you have already received. Administering a second dose, however, will not endanger your health.
Vaccination Requirement Waiver
Upon the panel physician’s recommendation, a consular officer may authorize a waiver if it is determined that a required vaccination is medically inappropriate because of your age, health condition or medical history. The U.S. Citizenship and Immigration Services (USCIS) may also authorize a waiver if you can establish that compliance with the vaccination requirements would be contrary to your religious beliefs or moral convictions.
Results of Medical Examination
The authorized physician will either give the applicant the medical examination results to hand-carry to the visa interview or will send the results directly to the U.S. Embassy or Consulate.
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