# Chapter 3 - Applicability of Medical Examination and Vaccination Requirement

- Guidance
- Resources (9)
- Appendices (0)
- Updates (7)
- History (1)

## A. Requirements by Benefit Type

Medical examination and vaccination requirements vary depending on the immigration benefit the person is seeking. 

Most applicants subject to medical grounds of inadmissibility must undergo a medical examination to determine their admissibility. Some applicants, however, do not need to undergo a medical examination unless there is a specific concern. Nonimmigrants, for example, are in this category.

Even if the applicant is not subject to health-related grounds of inadmissibility, the officer may still order a medical examination as a matter of discretion if the evidence indicates that there may be a public health concern.**[1]** This could apply, for example, when an officer adjudicates a request for parole.**[2]**

In general, an immigration officer may order a medical examination of an applicant at any time, if the officer is concerned that the applicant may be medically inadmissible.**[3]** This rule applies regardless of the type of immigration benefit sought, or whether the applicant is applying for a visa, seeking entry at a U.S. port-of-entry, or already in the United States. 

A civil surgeon in the United States can only perform a medical examination for purposes of a benefits application processed within the United States. Similarly, a panel physician abroad can generally only perform a medical examination for purposes of a visa application processed outside the United States. There are limited exceptions where an applicant seeking a benefit application inside the United States does not have to repeat a medical examination performed by a panel physician. The following chart highlights the benefits that require a medical examination and vaccinations, and whether a civil surgeon or panel physician should conduct the medical examination.**[4]**

## B. Special Considerations

### 1. Nonimmigrants and TPS Applicants

In general, nonimmigrant visa applicants, nonimmigrants seeking change or extension of status, and Temporary Protected Status (TPS) applicants are only medically examined if the consular officer or immigration officer has concerns as to the applicant’s inadmissibility on health-related grounds. Customs and Border Protection (CBP) officers at ports-of-entry may also require a nonimmigrant arriving with or without a visa to submit to a medical examination to determine whether a medical ground of inadmissibility applies.

### 2. K or V Visa Applicants Applying with DOS**[26]**

While the consular officer may encourage compliance, the consular officer cannot deny a K or V visa for lack of compliance with the vaccination requirements. 

Some panel physicians may perform the vaccination assessment in anticipation of the applicant’s later adjustment of status application.

### 3. Nonimmigrants Applying for Change of Status to V Status

For nonimmigrants applying for change of status to V status, the civil surgeon may perform the vaccination assessment in anticipation of the applicant’s later adjustment of status application.

### 4. K or V Nonimmigrants Applying for Adjustment**[27]**

K and V nonimmigrants applying for adjustment of status are not required to repeat the medical examination if the application was filed within one year of the date of the original medical examination, and:
                    -  The medical examination did not reveal a Class A medical condition; or  
                    -  The applicant received a conditional waiver in conjunction with the K or V nonimmigrant visa or the change of status to V and the applicant submits evidence of compliance with the waiver terms and conditions.**[28]** 

If a new medical examination is required and reveals a Class A medical condition, a new waiver application will also be required. In such cases, the officer should determine whether the applicant complied with the terms and conditions of the first waiver, if applicable. Such determination should be given considerable weight in the adjudication of a subsequent waiver application.**[29]**

Even if a new medical examination is not required, applicants must still comply with the vaccination requirements if the vaccination record was not included as part of the original medical examination report. If the vaccination report was properly completed at the time of the overseas examination, the officer may accept the vaccination assessment completed by the panel physician. 

An applicant’s overseas medical examination report completed by a panel physician should already be in the applicant’s A-file. If it is not in the A-file, the officer should request the medical examination report through a Request for Evidence (RFE).

If the applicant was granted a change of status to V in the United States,**[30]** the medical examination report completed by the civil surgeon should be in the A-file created at the time that the change of status was initially granted. 

### 5. Refugees Applying for Adjustment**[31]**

By regulation, refugees applying for adjustment of status generally do not need to repeat the entire medical examination if the applicant was already examined by a panel physician for purposes of admission to the United States.**[32]** Refugees must undergo an additional medical examination only if the original examination by the panel physician revealed a Class A medical condition.

Family members granted refugee status in the United States must submit to a medical examination at the time they seek to adjust their status. 

All refugees must comply with the vaccination requirements at the time of adjustment of status by submitting the relevant parts of the Report of Immigration Medical Examination and Vaccination Record (Form I-693) completed by a designated civil surgeon. A prior vaccination assessment performed by the panel physician cannot be used for purposes of the adjustment of status application.**[33]**

USCIS granted a blanket civil surgeon designation to state and local health department physicians for the limited purpose of completing the vaccination record for refugees applying for adjustment of status. 

### 6. Asylees Applying for Adjustment

All asylees are required to undergo an immigration medical exam, including vaccination assessment, at time of adjustment.**[34]**

However, according to USCIS policy developed in consultation with the Centers for Disease Control and Prevention, an asylee dependent who had a medical examination conducted overseas is not required to undergo a new medical exam when applying for adjustment of status if:
                    -  The results of the overseas medical examination are contained in the A-file and no Class A condition was reported;  
                    -  The asylee has applied for adjustment of status within one year of eligibility to file; and 
                    -  No evidence in the A-file or testimony given at the interview suggests that the asylee has acquired a Class A condition after his or her entry into the United States. 

Even if an asylee dependent may use the result of the previous examination, he or she must still establish compliance with the vaccination requirements and submit the vaccination assessment with his or her adjustment of status application. This requirement applies even if the applicant had a vaccination assessment completed overseas by a panel physician. To comply with the requirement, the applicant must have the relevant parts of Form I-693 completed by the civil surgeon.

### 7. Certain Afghan Nationals Applying for Adjustment of Status Following Evacuation Under Operation Allies Welcome

Afghan nationals who arrived in the United States under Operation Allies Welcome (OAW)**[35]** and completed an immigration medical examination abroad are not required to repeat the immigration medical examination when applying for adjustment of status if:
                    -  The results of the immigration medical examination completed abroad are contained in the A-file and no Class A medical condition was reported; 
                    -  The immigration medical examination abroad was completed by the panel physician no more than 4 years before the date the applicant files the application for adjustment of status; and 
                    -  No evidence in the A-file or testimony given at the interview suggests that the applicant has acquired a Class A medical condition after entry into the United States. 

### 8. Children of Returning Residents Entering the United States**[36]**

For children of returning residents entering the United States, as long as the parent’s visa is valid or the parent is a U.S. resident or U.S. national, there are no medical examination or vaccination requirements.

Children of returning residents entering the United States are: 
                    -  Children born abroad after the parent has been issued an immigrant visa and while the parent is applying for admission to the United States. 
                    -  Children born abroad during the temporary visit abroad of a mother who is a national or permanent resident of the United States.  

### 9. Internationally Adopted Orphans**[37]**

Children 10 years of age or younger who are classified as orphans and who are applying for IR-3 and IR-4 (orphans) and IH-3 and IH-4 (Hague Convention adoptees) visas are not required to comply with the vaccination requirements before admission to the United States.**[38]**

## Footnotes

----

[^ 1] Based on the conditions listed in INA 212(a)(1).

[^ 2] See INA 212(d)(5)(A).

[^ 3] See *Matter of Arthur   (PDF)*, 16 I&N Dec. 558 (BIA 1978) (The applicant has the burden of proof to establish his or her admissibility to the United States according to INA 291; the burden never shifts to the government).

[^ 4] Special considerations that apply to certain benefit types are noted in Section B, Special Considerations [8 USCIS-PM B.3(B)].

[^ 5] See INA 248. See 8 CFR 214.1 and 8 CFR 248.

[^ 6] See Section B, Special Considerations [8 USCIS-PM B.3(B)].

[^ 7] See INA 244.

[^ 8] See Section B, Special Considerations [8 USCIS-PM B.3(B)].

[^ 9] See INA 214. See 8 CFR 214.2(k) and 8 CFR 214.15.

[^ 10] See INA 214(q) and 8 CFR 214.15. 

[^ 11] See INA 245 and 8 CFR 245.

[^ 12] See Section B, Special Considerations [8 USCIS-PM B.3(B)].

[^ 13] See INA 207 and 8 CFR 207.7. See INA 208 and 8 CFR 208.21.

[^ 14] See INA 207 and 8 CFR 207.

[^ 15] See INA 208 and 8 CFR 208.

[^ 16] See INA 208 and 8 CFR 208.21.

[^ 17] See INA 209 and 8 CFR 209.1.

[^ 18] See Section B, Special Considerations [8 USCIS-PM B.3(B)].

[^ 19] Including state or local health department physicians, who are blanket designated by USCIS as civil surgeons for purposes of completing the vaccination record for refugees adjusting status only.

[^ 20] See INA 209 and 8 CFR 209.2.

[^ 21] See Section B, Special Considerations [8 USCIS-PM B.3(B)].

[^ 22] See 8 CFR 289.1 and 8 CFR 289.2. American Indians born in Canada who meet the regulatory requirements may be regarded as having been admitted for lawful permanent residence. Because neither an immigrant visa nor an adjustment of status application is required, the applicant is not required to comply with the medical examination and vaccination requirements.

[^ 23] See INA 101(a)(27)(A) and 22 CFR 42.22. 

[^ 24] See INA 101(b)(1)(F), including Hague Convention adoptees.

[^25] On August 29, 2021, President Biden directed DHS to lead implementation of ongoing efforts across the federal government to support vulnerable Afghan nationals, including those who worked alongside the U.S. Government in Afghanistan for the past 2 decades, as they safely resettled in the United States. These coordinated efforts were initially referred to as Operation Allies Refuge, and the operation has since been renamed Operation Allies Welcome (OAW). See the DHS OAW webpage. 

[^ 26] See INA 214. See 8 CFR 214.2(k) and 8 CFR 214.15. See 9 FAM 302.2-3(A), Medical Examinations – Medical Examination for Fiancé(e)s.

[^ 27] See INA 245 and 8 CFR 245.

[^ 28] See 8 CFR 245.5.

[^ 29] See Volume 9, Waivers and Other Forms of Reliefs, Part D, Health-Related Grounds of Inadmissibility [9 USCIS-PM D] for more information on medical waivers.

[^ 30] Under INA 214(q).

[^ 31] See INA 209 and 8 CFR 209.1.

[^ 32] See 8 CFR 209.1(c).

[^ 33] See 8 CFR 209.1(c).

[^ 34] See 8 CFR 209.2(d).

[^35] On August 29, 2021, President Biden directed DHS to lead implementation of ongoing efforts across the federal government to support vulnerable Afghan nationals, including those who worked alongside the U.S. Government in Afghanistan for the past 2 decades, as they safely resettled in the United States. These coordinated efforts were initially referred to as Operation Allies Refuge, and the operation has since been renamed Operation Allies Welcome (OAW). See the DHS OAW webpage. 

[^ 36] See INA 101(a)(27)(A) and 22 CFR 42.22. 

[^ 37] See INA 101(b)(1)(F). See Chapter 9, Vaccination Requirement, Section G, Exception for Certain Adopted Children [8 USCIS-PM B.9(G)] for more on this exception.

[^ 38] See INA 212(a)(1)(C), as amended by Section 2 of the International Adoption Simplification Act, Pub. L. 111-287   (PDF), 124 Stat. 3058, 3058 (November 30, 2010).

## Resources

42 CFR 34 - Medical examination of aliens

42 U.S.C. 252 - Medical examination of aliens

INA 212(a)(1) - Health-related grounds

INA 221(d) - Physical examination

INA 232, 8 CFR 232 - Detention of aliens for physical and mental examination

Technical Instructions for Civil Surgeons

G-28, Notice of Entry of Appearance as Attorney or Accredited Representative

I-693, Report of Medical Examination and Vaccination Record

How to Use the USCIS Policy Manual Website (PDF, 2.99 MB)

## Appendices

No *appendices* available at this time.

## Updates

February 01, 2022

U.S. Citizenship and Immigration Services (USCIS) is issuing policy guidance in the USCIS Policy Manual to allow certain Afghan nationals applying for adjustment of status after evacuation under Operation Allies Welcome (OAW) to use the report of an immigration medical examination completed abroad by a panel physician to satisfy the requirement normally demonstrated on a Report of Medical Examination and Vaccination Record (Form I-693) completed by a USCIS-designated civil surgeon, as long as certain conditions are met.

Read More

8 USCIS-PM B.3 - Chapter 3 - Applicability of Medical Examination and Vaccination Requirement

May 11, 2021

This technical update replaces all instances of the term “alien” with “noncitizen” or other appropriate terms throughout the Policy Manual where possible, as used to refer to a person who meets the definition provided in INA 101(a)(3) [“any person not a citizen or national of the United States”].

1 USCIS-PM - Volume 1 - General Policies and Procedures

2 USCIS-PM - Volume 2 - Nonimmigrants

6 USCIS-PM - Volume 6 - Immigrants

7 USCIS-PM - Volume 7 - Adjustment of Status

8 USCIS-PM - Volume 8 - Admissibility

9 USCIS-PM - Volume 9 - Waivers and Other Forms of Relief

10 USCIS-PM - Volume 10 - Employment Authorization

11 USCIS-PM - Volume 11 - Travel and Identity Documents

12 USCIS-PM - Volume 12 - Citizenship and Naturalization

May 21, 2020

U.S. Citizenship and Immigration Services (USCIS) is updating and incorporating relevant Adjudicator’s Field Manual (AFM) content into the USCIS Policy Manual. As that process is ongoing, USCIS has moved any remaining AFM content to its corresponding USCIS Policy Manual Part, in PDF format, until relevant AFM content has been properly incorporated into the USCIS Policy Manual. To the extent that a provision in the USCIS Policy Manual conflicts with remaining AFM content or Policy Memoranda, the updated information in the USCIS Policy Manual prevails. To find remaining AFM content, see the crosswalk (PDF, 316.97 KB) between the AFM and the Policy Manual.

1 USCIS-PM - Volume 1 - General Policies and Procedures

2 USCIS-PM - Volume 2 - Nonimmigrants

3 USCIS-PM - Volume 3 - Humanitarian Protection and Parole

4 USCIS-PM - Volume 4 - Refugees and Asylees

5 USCIS-PM - Volume 5 - Adoptions

6 USCIS-PM - Volume 6 - Immigrants

7 USCIS-PM - Volume 7 - Adjustment of Status

8 USCIS-PM - Volume 8 - Admissibility

9 USCIS-PM - Volume 9 - Waivers and Other Forms of Relief

11 USCIS-PM - Volume 11 - Travel and Identity Documents

12 USCIS-PM - Volume 12 - Citizenship and Naturalization

October 08, 2019

This technical update replaces all instances of the term “foreign national” with “alien” throughout the Policy Manual as used to refer to a person who meets the definition provided in INA 101(a)(3) [“any person not a citizen or national of the United States”].

1 USCIS-PM - Volume 1 - General Policies and Procedures

2 USCIS-PM - Volume 2 - Nonimmigrants

6 USCIS-PM - Volume 6 - Immigrants

7 USCIS-PM - Volume 7 - Adjustment of Status

8 USCIS-PM - Volume 8 - Admissibility

9 USCIS-PM - Volume 9 - Waivers and Other Forms of Relief

10 USCIS-PM - Volume 10 - Employment Authorization

11 USCIS-PM - Volume 11 - Travel and Identity Documents

12 USCIS-PM - Volume 12 - Citizenship and Naturalization

October 16, 2018

U.S. Citizenship and Immigration Services (USCIS) is updating policy guidance in Volume 8, Part B of the USCIS Policy Manual regarding the period of time during which a Form I-693 submitted in support of a related immigration benefits application is considered valid.

Read More

8 USCIS-PM B - Part B - Health-Related Grounds of Inadmissibility

November 02, 2016

U.S. Citizenship and Immigration Services (USCIS) is updating guidance regarding health-related grounds of inadmissibility in accordance with the U.S. Department of Health and Human Services (HHS) rulemaking updating Title 42 of the Code of Federal Regulations, part 34 (42 CFR 34).

Read More

8 USCIS-PM B - Part B - Health-Related Grounds of Inadmissibility

January 28, 2014

U.S. Citizenship and Immigration Services (USCIS) is issuing guidance in the USCIS Policy Manual on the health-related grounds of inadmissibility under INA 212(a)(1) and corresponding waivers under INA 212(g).

Read More

8 USCIS-PM B - Part B - Health-Related Grounds of Inadmissibility

9 USCIS-PM D - Part D - Health-Related Grounds of Inadmissibility

#### Archived Content

This content has been superseded by the current version available in the Guidance tab. The historical versions linked below reflect the pertinent policy in effect on that date and dates reflect when updates occurred. The historical versions are provided for research and reference purposes only. USCIS employees should not rely on the historical versions for current laws, precedent decisions, policies, directives, guidance, and procedures.

The History tab was added to the USCIS Policy Manual on June 11, 2021, and provides historical versions on and after that date. For historical versions before June 11, 2021, navigate to the USCIS Policy Manual within the USCIS website at: https://archive.org

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