Immigrant and Refugee Health

Technical Instructions for Civil Surgeons

On October 6, 2008, HHS/CDC posted an Interim Final Rule (IFR) regarding regulations that establish requirements for the medical examination of aliens. The IFR does not currently affect the required medical examination performed by civil surgeons. Civil surgeons should continue to follow the procedures outlined in the current Technical Instructions for Civil Surgeons.

Updates for Civil Surgeons

On January 13th, 2017, CDC published a Morbidity and Mortality Weekly Report (MMWR) article documenting a change in guidance for the assessment of poliovirus vaccination status of children who have received the poliovirus vaccine outside of the United States. The report states that documentation of poliovirus vaccination given outside of the United States is now valid only when documentation indicates receipt of either IPV or tOPV. Please note this change as it relates to the vaccination component of the medical examination for those seeking adjustment of status within United States.
ACIP has released a new immunization schedule, which became effective on February 1, 2017. Please note that the updated guidance regarding Polio is not reflected in this new schedule.
The Technical Instructions have been updated regarding the scope of the medical examination for all applicants. For details, please see the Syphilis, Gonorrhea, and Medical History and Physical Examination Technical Instructions for Civil Surgeons.
The Other Sexually Transmitted Diseases Technical Instructions were replaced with the Gonorrhea Technical Instructions. The Gonorrhea Technical Instructions are to be followed by civil surgeons for gonorrhea screening and treatment as soon as possible and no later than August 1, 2016.
As of March 28, 2016, chancroid, lymphogranuloma venerum, and granuloma inguinale are removed from the list of communicable diseases of public health significance. Therefore, evaluation for these three diseases is no longer required as part of the U.S. immigration medical screening process as of March 28, 2016. For additional information, please see Part 34 Final Rule issued on January 26, 2016.
CDC has updated the 2010 Technical Instructions for Physical or Mental Disorders with Associated Harmful Behaviors and Substance-Related Disorders (MH TIs).
April 2013 Update for Civil Surgeons: Regarding Current Nationwide TUBERSOL® Shortage. See more »
April 2013 Update to the Technical Instructions for treatment of Other Sexually Transmitted Diseases (chancroid, gonorrhea, granuloma inguinale, and lymphogranuloma venereum). See more »
Effective January 1, 2013, the 2013 Technical Instructions for Syphilis and Hansen’s Disease replace the 1991 Technical Instructions for these components. For more information, see the Frequently Asked Questions for the 2013 Technical Instructions for Syphilis and Hansen’s Disease.
Guidance based on 2010 Recommendations for the Seasonal Influenza (Flu) Vaccine.
On January 4, 2010, HIV infection was removed from the list of inadmissible conditions for immigration purposes and from the scope of the immigrant medical examination. See Guidance for HIV for Civil Surgeons.
Guidance for Option of Using Interferon Gamma Release Assay in Place of Tuberculin Skin Test for Civil Surgeons.