Domestic Medical Screening Guidance for Newly Arrived Refugees

Development and Review Process

The Domestic Medical Screening Guidance (formerly known as the Domestic Medical Screening Guidelines) is the culmination of a collaborative process based on available evidence-based national screening recommendations and accepted clinical best practices in refugee health. These guidance documents:

  • outline what should be addressed during the domestic medical screening and initial primary care follow-up visits, and
  • discuss additional considerations for ongoing care.

The domestic screening guidance is intended to provide recommendations, not mandates, and each section is designed to be flexible, allowing clinicians to adapt the screening process to meet the needs of each refugee.

The Division of Global Migration and Quarantine (DGMQ) first began developing the Domestic Medical Screening Guidelines in September 2006. Each section was written and reviewed by refugee health and subject-matter experts. Additionally, sections were critically reviewed by a Federal Partners Working Group, which included representatives from the Department of Health and Human Services’ (HHS) Offices of Refugee Resettlement and Global Health Affairs; the Department of State’s Bureau of Population, Refugees, and Migration; and the Substance Abuse and Mental Health Services Administration. The original guidelines were subject to additional review by an elected body of state refugee health coordinators.

In 2015, DGMQ initiated a comprehensive review of the Domestic Medical Screening Guidance, in partnership with the Centers of Excellence in Refugee Healthexternal icon (Minnesota Department of Health). The revised guidance has been reviewed, written, and edited by a panel of experts in refugee health. Each section is then reviewed by refugee health and subject-matter experts outside CDC, including clinicians, social workers, and researchers who work domestically and internationally. Each section receives further critical review and editing through an official clearance process within CDC. DGMQ also receives comments regularly from clinicians at national conferences and meetings, and through individual inquiries. Guidance is updated as new information becomes available.

When the Domestic Screening Guidelines were first developed, much thought and discussion went into the naming of the guidelines, the intended audience, and how content would be maintained and revised. In 2012, the CDC Office of the Associate Director for Science introduced the Guidelines and Recommendations Team, which set new standards for CDC guidelines and implemented a rigorous review policy for guideline documents. This has prompted a change in terminology. As our content undergoes a different review process, as of October 2020, the Domestic Medical Screening Guidelines were renamed as the Domestic Medical Screening Guidance. DGMQ’s guidance draws heavily from existing domestic and international guidelines, and is tailored to a specific provider audience and patient population. As refugee populations are diverse and everchanging, it is important that DGMQ’s guidance is nimble, allowing for changes as new epidemiological and medical information becomes available.

Completed guidance documents are posted on the Immigrant and Refugee Health webpage as they become available. Partners receive notification letters from CDC regarding changes to the domestic screening guidance. The HHS Office of Refugee Resettlementexternal icon, the Association for Refugee Health Coordinatorsexternal icon (ARHC), and the Society of Refugee Healthcare Providersexternal icon help distribute these CDC notification letters to their partners. Additionally, guidance is also uploaded to the clinical decision-making tool, CareRefexternal icon (Minnesota Department of Health), as it becomes available.

Please contact the Domestic Team (irmhdomestic@cdc.gov) with questions regarding the Domestic Medical Screening Guidance.

Primary Authors
  • Cristina Baker (Tuberculosis)
  • Elizabeth Barnett (Immunizations)
  • Maria Cano (STI/Syphilis)
  • Rajal Mody (Lead)
  • Suzinne Pak-Gorstein (Nutrition, Growth and Development)
  • Doug Pryce (Vitamin D)
  • Meghan Rothenberger (History and Physical)
  • Dan Savin (Mental Health)
  • Dean Tsukyama (Tuberculosis)
  • John Tuskan (Mental Health)
  • Louise E Vaz (HIV)
  • Judd Walson (HIV)
Expert Reviewers
  • Elizabeth Barnett
  • Gulshan Bhatia
  • David Boulware
  • Jennifer Cochran
  • Kris Ehresman
  • David Eisenman
  • Phil Fischer
  • Carlos Franco-Paredes
  • Paul Geltman
  • Ann Giesel
  • Olga Gorbacheva
  • Christine Greenaway
  • Keith Henry
  • Michael Holick
  • Randy Hurley
  • Jim Jaranson
  • Chandy John
  • Georgi Krupin
  • Alan Magill
  • Stacene Maroushek
  • Chris May
  • Kathy Moser
  • Masa Narita
  • Cindy Nelson
  • Suzinne Pak-Gorstein
  • Mrinal Patanik
  • Mara Rabin
  • Brian Rock
  • Ann Settgast
  • Patricia Shannon
  • Margaret Simpson
  • Deb Sodt
  • Jeff Starke
  • Steve Swanson
  • Paul Swoboda
  • Dean Tsukyama
  • Patricia Walker