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Frequently Asked Questions: Vaccination Technical Instructions for Civil Surgeons

1. What can be considered proof of valid immunizations?

Acceptable immunization documentation must come from a vaccination record. This is either a personal vaccination record or a copy of the medical record with entries made by a physician or appropriate medical personnel. Only those records of doses of vaccines that include the dates of receipt (month, day, and year) are acceptable. Self-reported doses of vaccines without written documentation are not acceptable. If vaccination records presented by an applicant appear to have been altered, the civil surgeon should disregard the records and consider the applicant to be unvaccinated.

2. What vaccines should be administered to a person with an inadequately documented vaccine history?

If the applicant is unable to produce a written vaccination record or if in the civil
surgeon’s opinion the record is inadequate, every effort should be made to vaccinate the applicant unless a contraindication exists.  The vaccines routinely recommended by the U.S. Advisory Committee on Immunization Practices (ACIP) based on the applicant’s age must be administered.  Specific information on vaccines, including tables on age-appropriate vaccines and ACIP recommendations, are available at CDC’s National Center for Immunization and Respiratory Diseases website:  http://www.cdc.gov/vaccines.

3. For a person who has had no vaccines or whose vaccines are not up to date, do all doses of the required vaccines need to be given?

Because completion of the vaccine series often requires several months, applicants are not required to have received all doses of the ACIP-recommended vaccines to fulfill the vaccination requirements for adjustment of status to U.S. permanent residence.  Rather, applicants are required to have received at least one dose of each vaccine and are encouraged to follow up with a primary health-care provider to complete the series once they are in the United States.

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4. Is there a vaccination requirement for children adopted from other countries by U.S. residents?

Children 10 years of age or younger who are adopted from other countries are exempt from vaccination requirements if the parent adopting the child signs an affidavit that he or she will ensure that the child receives the required vaccinations within 30 days after the child’s arrival into the United States.

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5. Is there a vaccination requirement for refugees?

Vaccination requirements do not apply to refugees at the time of their initial admission to the United States.  However, refugees must meet the vaccination requirements when they apply for adjustment of status or permanent resident status in the United States. 

For refugees, the adjustment of status application includes the medical examination report issued by the panel physician overseas and Form I-693, indicating the vaccination assessment performed by a civil surgeon.

The civil surgeon must review all vaccination records presented by the refugee during this process and record the vaccination assessment results on Form I-693.  The required vaccines must be administered.  Because a refugee has already had the overseas examination, only the following sections of Form I-693* need to be completed: 

• Part 1.    Information about you (The applicant must complete this part.)
• Part 2.
  • 5.  Vaccinations (The civil surgeon must complete this part.)
• Part 5.  Civil Surgeon’s Certification (The civil surgeon must complete this part.)

*Exception:  Refugees who enter the United States with a Class A condition need a complete medical examination by a civil surgeon at the time of adjustment of status.  In this case, all pertinent sections of the form must be completed.

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6. What needs to be completed by the health departments acting as civil surgeons for refugees?

Because refugees had an overseas examination and are not required to undergo a medical examination when they apply for adjustment of status or permanent resident status in the United States, only the following sections of Form I-693* need to be completed:

• Part 1.    Information about you (The applicant must complete this part.)
• Part 2.
  • 5.  Vaccinations (The physician or other health-care professional at the health department must complete this part.)
• Part 6.  Health department identifying information (The health department professional must complete this part.)

The signature in Part 6 must be that of the physician at the health department.  It may be an actual (original) or stamped signature.  The health department nurse or other health-care professional may, but is not required to, co-sign the form.

*Exception:  Refugees who enter the United States with a Class A condition need a complete medical examination by a civil surgeon at the time of adjustment of status.  In this case, all pertinent sections of the form must be completed.

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7. What if a required vaccine is not immediately available through the civil surgeon?

It is the civil surgeon’s responsibility to ensure that all required vaccines are available to the applicant.  However, if a required vaccine is not immediately available, the civil surgeon may refer the applicant to a facility, e.g., health department, where the vaccine is available.

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8. Is it an acceptable practice to administer several required vaccines simultaneously?

Yes, many of the commonly used vaccines can be safely and effectively administered simultaneously (that is, on the same day but not at the same anatomical site).  The simultaneous administration of the most widely used live and inactivated vaccines has not resulted in impaired antibody responses or increased rates of adverse reactions.

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