USCIS Medical Examination Requirements
All immigrants, refugees, and applicants for permanent U.S. residence must undergo a standardized medical examination that includes tuberculosis screening, vaccination verification, and testing for specific communicable diseases as mandated by U.S. immigration law.
Core Required Tests
Tuberculosis Screening (Primary Focus)
The tuberculosis screening protocol is age-dependent and represents the most critical component of the USCIS medical examination:
- For persons ≥15 years of age: Chest X-ray examination is mandatory 1
- For persons <15 years of age: Tuberculin skin test is required only if the child is symptomatic or has a family member with suspected tuberculosis 1
If the chest radiograph suggests active pulmonary tuberculosis, additional testing with sputum smears for acid-fast bacilli is required 1. Since 2007, enhanced standards include sputum cultures (which are more sensitive than smears alone) as a diagnostic tool 2.
Communicable Disease Testing
The following infectious diseases are grounds for inadmissibility and require screening:
- Infectious tuberculosis (as detailed above) 3
- Syphilis testing: Required for all applicants, with screening identifying primary, secondary, and latent syphilis 3
- Gonorrhea testing: Added to requirements in 2016 3
- HIV infection: Testing is mandatory as an excludable condition 1
- Hansen's disease (leprosy): Screening for infectious cases 1
Medical History and Physical Examination
A comprehensive evaluation includes:
- Brief history of present and past illness 1
- Physical and mental examination to identify excludable conditions as specified in the Immigration and Nationality Act 1
Vaccination Requirements
Refugees receive additional voluntary interventions during overseas examination, including vaccinations 3:
- Measles-containing vaccine coverage reached 96% for first dose and 80% for second dose by 2019 3
- Other age-appropriate vaccinations per CDC guidelines are offered 3
Important Clinical Considerations
Classification System
The examination uses a classification system that determines admissibility:
- Class A conditions: Excludable (e.g., infectious TB with positive sputum smears) 1, 3
- Class B conditions: Admissible but require follow-up (e.g., completed TB treatment, latent TB infection, TB contacts) 3
Common Pitfalls
Key issues to avoid in the examination process:
- The examination must be performed by designated "panel physicians" appointed by U.S. embassies and consulates, not just any licensed physician 1
- Tuberculin skin testing is NOT routinely required for adults ≥15 years due to quality control concerns and logistical challenges 1
- Cultures for M. tuberculosis were not historically required but became standard after 2007 reforms 1, 2
- In 2012,60% of TB cases diagnosed were smear-negative but culture-positive, demonstrating the importance of culture testing 2
Post-Arrival Follow-Up
For persons with Class B TB conditions, domestic follow-up examination is recommended within 90 days of U.S. arrival 3, 4:
- Among those with complete postarrival examinations, 688 per 100,000 persons with Class B0 or B1 TB were diagnosed with culture-positive TB disease within the first year 3
- Screening coverage during domestic examinations shows high rates for TB (91.6%), hepatitis B (95.8%), and HIV (80.3%) 4
Examination Location
The overseas medical examination is conducted abroad before visa issuance by panel physicians in approximately 400 locations worldwide 1. For persons already in the United States adjusting their immigration status (including nonimmigrants, refugees, or asylees applying for permanent residence), the examination must be performed by a designated "civil surgeon" 1.