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Required Evaluation Components Other Physical or Mental Abnormality, Disease or Disability

Technical Instructions for the Medical Examination of Aliens in The United States

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The Centers for Disease Control (CDC), United States Public Health Service (PHS), is responsible for ensuring that aliens entering the United States do not pose a threat to the public health of this country.  The medical examination is one means of evaluating the health of aliens applying for admission or adjustment of status as permanent residents in the United States.

These instructions are for the use of civil surgeons and Immigration and Naturalization Service (INS) officials who are evaluating aliens applying for adjustment of status to permanent resident, and any other alien required by INS to have a medical examination.  This document supersedes the June 1985 Guidelines for Medical Examination of Aliens in the United States.

Required Evaluation Components

Communicable Disease of Public Health Significance: Human Immunodeficiency Virus (HIV) Infection

  1. Required Evaluation
    • All applicants 15 years of age or older must be tested for evidence of HIV infection.
    • Applicants under the age of 15 must be tested if there is reason to suspect HIV infection, (e. g., a child with hemophilia, or a child whose mother or father is HIV-positive.)
  2. Tests for HIV Infection
    • Any accepted HIV antibody screening test (e.g., ELISA test or equivalent) may be used. If the initial test is positive or indeterminate, it should be repeated on the same serum specimen, and if still positive or indeterminate, a confirmatory test (Western Blot or equivalent) should be done on the same specimen before the results are reported.
    • If the result of the Western Blot is indeterminate or equivocal, another specimen, drawn at least 30 days later should be retested. If the result of the second test is indeterminate, the specimen should be sent to the nearest reference laboratory. The medical report should not be completed until the results from the reference laboratory are obtained.
  3. Pre- and Posttest Counseling for HIV infection
    • Before a blood test for HIV antibody is performed, the applicant should be aware of the following:
    • A blood test for the antibody to the human immunodeficiency virus (HIV) is required as a part of your medical examination. HIV is the virus that causes the acquired immunodeficiency syndrome (AIDS). AIDS is the name given to a group of illnesses that may occur in persons infected with HIV. Infection with HIV causes a defect in a person’s natural immunity against disease. This defect leaves infected people vulnerable to serious illnesses that would not usually be a threat to anyone whose immune system was intact. This test is not to diagnose AIDS but to detect antibodies to the virus.
    • The results of your test will be provided to an INS officer. Also, it may be necessary to report results to the state or local health authority. A positive test result may mean that you may not be eligible for adjustment of status. A positive test result could also have other local consequences on your day-to-day activities.
    • The civil surgeon should advise an applicant who has tested positive for HIV infection (a positive test is a repeatedly positive antibody screening test such as ELISA supported by a positive test result in supplemental test such as the Western Blot test or an equally reliable test) to return to the civil surgeon’s office to discuss the results of the tests and receive initial counseling.
    • The civil surgeon must provide basic information to applicants who are HIV-positive and refer them for counseling and early medical intervention if these services are available. Important points the civil surgeon should cover include information about the test and the prognosis, and ways the person can protect others and self.
  4. Reporting Results of Tests for HIV Infection
    Laboratories should report tests results as negative, positive, or indeterminate. If a laboratory screens for both HIV-1 and HIV-2, both results should be reviews and reported. Results of HIV tests are to be recorded on the medical report as follows:
    Report from Laboratory Record on Medical Report Form
    Screening test (ELISA or equivalent) negative HIV Negative
    Screening test repeatedly indeterminate or positive and confirmatory test positive HIV Positive – Class A Condition
    Screening test repeatedly indeterminate or positive and confirmatory test negative HIV Negative
    Screening test repeatedly indeterminate or positive and confirmatory test indeterminate -Do not complete medical report form; Repeat test in 30 days
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