Medical Screening of US-Bound Refugees

Iraqi Refugee Health Profile

Iraqi refugees who have been identified for resettlement in the United States receive additional medical assessments (Figure 5). As outlined below, some assessments occur several months prior to the refugees’ departure, and some occur immediately before departure to the United States.

Figure 5: Medical Assessment of US-bound refugees

Medical assessment of US-bound refugees flowchart

* Class B1 TB refers to TB fully treated by directly observed therapy, or abnormal chest x-ray with negative sputum smears and cultures, or extrapulmonary TB.

Visa Medical Examination

A visa medical examination is mandatory for all refugees coming to the United States and must be performed according to the CDC’s Technical Instructions for visa medical examinations. The purpose of the medical examination is to identify applicants with inadmissible health-related conditions. Panel physicians, selected by Department of State consular officials, perform these examinations. CDC provides the technical oversight and training for the panel physicians. Information collected during the refugee visa medical examination is reported to CDC’s Electronic Disease Notification System (EDN) and is available to state health departments where the refugees are resettled. For refugee applicants, panel physicians must complete a US Department of State Vaccination Documentation Worksheet (DS-3025) if reliable documents are available.

Pre-Departure Medical Screening

In Jordan, a pre-departure medical screening is conducted approximately 3 weeks before departure for the United States for refugees previously diagnosed with class B1 tuberculosis (tuberculosis fully treated by directly observed therapy, or abnormal chest x-ray with negative sputum smears and cultures, or extrapulmonary tuberculosis). The screening includes a repeat physical examination with a focus on tuberculosis signs and symptoms, chest x-ray, and sputum collection.

Pre-Embarkation Checks

IOM clinicians perform a pre-embarkation check within 24-48 hours of the refugee’s departure for the United States to assess fitness for travel and administer presumptive therapy for intestinal parasites.

Post-Arrival Medical Screening

Once refugees have arrived in the United States, CDC recommends that they receive a post-arrival medical screening  (domestic medical examination) within 30 days after arrival. The Office of Refugee Resettlement (ORR) reimburses providers for screenings conducted during the first 90 days after the refugee’s arrival. The purpose of these more comprehensive examinations is to assess the refugee’s health conditions and to introduce him or her to the US health care system. CDC provides guidelines and recommendations, and state refugee health programs oversee and administer the domestic medical examinations. State refugee health programs or private physicians conduct the examinations. State refugee health programs determine who conducts the examinations within their jurisdiction, and most state refugee health programs collect the data from the screenings.

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