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Immigration Laws and Infectious Disease Reporting

posted on Wed, Jan 6 2016 12:10 pm by The Network

Individuals who are seeking an adjustment of legal status to become permanent residents of the United States must submit a Report of Medical Examination and Vaccination Record, or I-693 Form, to establish admissibility. The form must be completed by a federally designated civil surgeon based on the surgeon’s medical examination. The Network was recently asked if the results of an I-693 exam can be reported to local health departments.

DHS Instructions for the I-693 form state that exam results are confidential, but the examining physician may share results with state or local public health authorities when required by law.

The Department of Homeland Security (DHS) Medical Examination of Aliens regulation states that all medical examinations must be carried out in accordance with the technical instructions for physicians issued by the Centers for Disease Control and Prevention (CDC) [42 C.F.R. 34.3(i)]. The technical instructions require the completed, original I-693 Form to be signed and placed in a sealed envelope for submission to the Citizenship and Immigration Services Office of DHS.

The CDC’s technical instructions for civil surgeons state that qualified physicians must submit DHS’ Form I-910 to be deemed a civil surgeon. State and local health departments are automatically given blanket civil surgeon designation, which allows health departments to complete the vaccination assessment section of the I-693 Form, but not the medical exam or other sections of the form. The I-910 Form states that civil surgeons are required by CDC’s technical instructions to file a case report with appropriate state or local public health authorities if required by local laws or regulations. Based on this language, it seems that CDC’s technical instructions affirmatively state that civil surgeons are required to comply with state and local reporting laws. 

However, CDC’s technical instructions do not discuss referring or reporting any condition (other than Tuberculosis (TB)) to state or local health officials. CDC’s TB medical examination technical instructions specifically require civil surgeons to refer patients with abnormal chest x-rays, which suggest the presence of TB, to the local health department’s TB control program. The civil surgeon is also required to keep a copy of the I-693 Form if the patient was referred to a TB program or other health care provider for treatment.

Although it may be presumed that other conditions (besides TB) noted on the I-693 Form or identified during the medical exam by the physician may be reported to state or local health authorities, this conclusion is not reflected in guidance provided by CDC.

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