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

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 U.S. Department of Homeland Security (DHS) officials who are evaluating aliens applying for adjustment of status to permanent resident, and any other alien required by DHS to have a medical examination. This document supersedes the June 1985 Guidelines for Medical Examination of Aliens in the United States.

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Introductions and Background(1)

A. The Medical Examination as Part of the Application for Adjustment of Status or Admission

Aliens applying for adjustment of status to permanent resident must have a physical and mental examination as part of the application process. The U.S. Department of Homeland Security (DHS) may also require aliens applying for admission into the United States to have a physical and mental examination if necessary to determine their admissibility. The purpose of the medical examination is to identify the presence or absence of certain disorders that could result in exclusion from the United States under the provisions of the Immigration and Nationality Act.

B. The Role of the Civil Surgeon

Civil surgeons must follow procedures prescribed by the DHS. Civil surgeons must ensure that the person appearing for the medical examination is the person who is actually applying for immigration benefits. The civil surgeon is responsible for reporting the results of the medical examination and all required tests on the prescribed forms. The civil surgeon is not responsible for determining whether an alien is actually eligible for adjustment of status; that determination is made by the INS officer after reviewing all records, including the report of the medical examination.

C. The 1990 Amendments to the Immigration and Nationality Act

The Immigration Act of 1990 (Pub. L. 101-649) amended the Immigration and Nationality Act (8 U.S.C. 1101 et seq.) (The Act) by substantially revising the health-related grounds for the exclusion of aliens applying for admission into the United States. The new law amends section 212 (8 U.S.C.) as follows:

212 "(a) CLASSES OF EXCLUDABLE ALIENS.- Except as otherwise provided in this Act, the following describes classes of excludable aliens who are ineligible to receive visas and who shall be excluded from admission into the United States:
"(1) HEALTH-RELATED GROUNDS.--
"(A) IN GENERAL.-- Any alien--
"(i) who is determined (in accordance with regulations prescribed by the Secretary of Health and Human Services) to have a communicable disease of public health significance,
"(ii) who is determined (in accordance with regulations prescribed by the Secretary of Health and Human Services in consultation with the Attorney General)--
"(I) to have a physical or mental disorder and behavior associated with the disorder that may pose, or has posed, a threat to the property, safety, or welfare of the alien or others, or
"(II) to have had a physical or mental disorder and a history of behavior associated with the disorder, which behavior has posed a threat to the property, safety, or welfare of the alien or others and which behavior is likely to recur or lead to other harmful behavior,
"(iii) who is determined (in accordance with regulations prescribed by the Secretary of Health and Human Services) to be a drug abuser or addict, is excludable."

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"(4) PUBLIC CHARGE.-- Any alien who, in the opinion of the consular officer at the time of application for a visa, or in the opinion of the Attorney General at the time of application for admission or adjustment of status, is likely at any time to become a public charge is excludable."

The health-related grounds for exclusion of aliens set forth in the law are implemented by a regulation, "Medical Examination of Aliens" (42 CFR, Part 34). This regulation identifies the groups of aliens requiring a medical examination, defines the process for examination and reporting, establishes the scope of the medical examination, and establishes where and by whom the medical examination will be done. In addition, the regulation lists certain disorders that, if identified during the medical examination of an alien, are grounds for exclusion (Class A condition) or represent such significant health problems (Class B condition) that they must be brought to the attention of consular authorities.

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D. Changes from the Previous Health-related Exclusion

Communicable Diseases of Public Health Significance

The previous law provided for a list of "dangerous contagious diseases" (active tuberculosis, infectious syphilis, chancroid, gonorrhea, granuloma inguinale, lymphogranuloma venereum, and Hansen's disease (leprosy)). Applicants with any of these diseases were excludable. The new law refers to these as "communicable diseases of public health significance."

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Mental Conditions

Under the old law, aliens who were mentally retarded, insane, had one or more attacks of insanity, were afflicted with psychopathic personality, sexual deviation, or mental defect, or who were narcotic drug addicts or chronic alcoholics were ineligible for admission or for adjustment of status to a permanent resident. As amended, the Immigration and Nationality Act no longer lists specific physical or mental conditions that automatically exclude an alien but instead requires a determination of whether an alien has a physical or mental disorder and associated behavior that has posed or is likely to pose a threat to the property, safety, or welfare of the alien or others.
Criminal Behavior

Aliens convicted of certain criminal acts are excludable under other sections of the Immigration and Nationality Act, regardless of their health status. A history of criminal behavior associated with a physical or mental condition that has posed a threat to the property, safety, or welfare of the alien or others, even without a conviction, may be used by the civil surgeon to determine whether an alien has an excludable condition.
Drug Abuse or Addiction

The amendments to the Act replace the previous exclusion of "narcotic drug addicts" with a broader category: "drug abuser or addict." The broader category includes aliens who are engaged in the nonmedical use of any substance named in section 202 of the Controlled Substances Act, as amended (21 U.S.C. 812).

Alcohol Abuse or Dependence (Alcoholism)

The Act as amended does not refer explicitly to alcoholics or alcoholism. Evaluation for alcohol abuse or dependence is included in the evaluation for mental and physical disorders with associated harmful behavior.

Exclusion on Public Charge Grounds

As under the previous law, in addition to the examination for specific excludable medical conditions, aliens will be examined for other physical or mental abnormalities, disorders, diseases, or disabilities that would be likely to render the alien unable to care for himself or herself or to attend school or work, or that might require extensive medical care or institutionalization. Thus, certain conditions (e.g., mental retardation) that are no longer explicitly listed as excludable conditions may result in exclusion under this section if the immigration officer determines that family or other resources to care for the person do not exist.

(1) From the 1991 Technical Instructions for Civil Surgeons