9 FAM 302.2 (U) INELIGIBILITY BASED ON HEALTH AND MEDICAL GROUNDS

9 FAM 302.2

(U) Ineligibility Based on Health and Medical Grounds - INA 212(a)(1)

(CT:VISA-2008; 06-11-2024)
(Office of Origin: CA/VO)

9 FAM 302.2-1 (U) Statutory and Regulatory Authority

9 FAM 302.2-1(A) (U) Immigration and Nationality Act

(CT:VISA-177; 09-15-2016)

(U) INA 101(a)(51) (8 U.S.C. 1101(a)(51)); INA 212(a)(1) (8 U.S.C. 1182(a)(1)); INA 212(a)(4) (8 U.S.C. 1182(a)(4)); INA 212(d)(3)(A) (8 U.S.C. 1182(d)(3)(A)); INA 212(g) (8 U.S.C. 1182(g)); INA 221(c) (8 U.S.C. 1201(c); INA 221(d) (8 U.S.C. 1201(d)).

9 FAM 302.2-1(B) (U) Code of Federal Regulations

(CT:VISA-177; 09-15-2016)

(U) 22 CFR 40.11; 22 CFR 40.301; 22 CFR 41.108; 22 CFR 42.66; 42 CFR Part 34.

9 FAM 302.2-2 (U) IN gENERAL - ina 212(a)(1)

9 FAM 302.2-2(A) (U) Grounds

(CT:VISA-1543; 05-17-2022)

a. (U) Communicable Disease of Public Health Significance: INA 212(a)(1)(i) provides that an individual is ineligible for a visa if the individual has a communicable disease of public health significance. See 9 FAM 302.2-5.

b. (U) Vaccinations: INA 212(a)(1)(A)(ii) provides that an individual is ineligible for an IV if the individual lacks the required vaccinations. See 9 FAM 302.2-6.

c. (U) Physical or Mental Disorders: INA 212(a)(1)(A)(iii) of the Immigration and Nationality Act provides that an individual is ineligible for a visa if the individual has a physical or mental disorder and behavior associated with that disorder that may pose, or has posed, a threat to the property, safety, or welfare of the individual or others, or a history of such behavior likely to occur or lead to other harmful behavior. See 9 FAM 302.2-7.

d. (U) Drug Addict or Abuse: INA 212(a)(1)(A)(iv) of the Immigration and Nationality Act provides that an individual is ineligible for a visa if the individual is a drug abuser or drug addict. See 9 FAM 302.2-8.

9 FAM 302.2-2(B) (U) Major Elements of Medical-Related Ineligibilities

(CT:VISA-1543; 05-17-2022)

(U) The major elements relating to a finding of ineligibility under INA 212(a)(1) for medical-related reasons include:

(1) (U) The general requirement for a medical examination, see 9 FAM 302.2-3;

(2) (U) The role of panel physicians, see 9 FAM 302.2-3(E);

(3) (U) Potential public charge factors, see 9 FAM 302.2-3(G);

(4) (U) Communicable diseases of public health significance, see 9 FAM 302.2-5(B);

(5) (U) Immunization requirements, see 9 FAM 302.2-6(B);

(6) (U) Physical or mental disorder with associated harmful behavior, see 9 FAM 302.2-7(B);

(7) (U) Drug abuse or addiction, see 9 FAM 302.2-8;

(8) (U) IV waivers, see 9 FAM 302.2-5(D)(1), 9 FAM 302.2-6(D)(1), 9 FAM 302.2-7(D)(1), and 9 FAM 302.2-8(D)(1);

(9) (U) NIV waivers, see 9 FAM 302.2-5(D)(2), 9 FAM 302.2-6(D)(2), 9 FAM 302.2-7(D)(2), and 9 FAM 302.2-8(D)(2); and

(10) Unavailable

9 FAM 302.2-3 (U) mEDICAL Examinations

9 FAM 302.2-3(A) (U) General Requirements

(CT:VISA-2008; 06-11-2024)

a (U) IV Applicants: INA 221(d) requires all applicants applying for IVs to undergo a physical and mental examination. The results of this statutorily required medical examination are used to determine the applicant's eligibility for such a visa. The medical finding by the panel physician or CDC, if referred to that agency, is binding on you. See 9 FAM 504.4-7.

(1) (U) Medical Exam Waiver for Certain Afghan SIV: On August 12, 2021, the Deputy Secretary of State for Management and Resources and the Deputy Secretary of Homeland Security jointly issued a blanket waiver of the requirement to undergo a medical exam before IV issuance or admission to the United States for certain Afghan SIV applicants who are in Afghanistan, who have met all requirements for SIV issuance other than the medical exam, and for whom the Chief of Mission has determined are unable to complete the required medical exam in a timely manner without undue hardship or risk to personal safety. Before deciding that this medical exam waiver is necessary, the Chief of Mission must assess all relevant decision points regarding conditions in Afghanistan, including availability of panel physicians, with the goal of encouraging as many Afghan SIV applicants as possible to undergo a medical exam before visa issuance. This waiver is valid through August 11, 2022, and may be extended for additional one-year periods.

(2) (U) You should inform Afghan SIV applicants eligible for this waiver that a medical exam is not required before visa issuance or admission, but that they must undergo a medical exam no later than 30 days after admission into the United States per the procedures established by the Department in coordination with DHS, HHS, and entities providing resettlement services domestically to Afghan SIV immigrants. Those eligible for a waiver will be considered, at the time of admission, lawfully admitted for permanent residence on a conditional basis. Upon confirmation that the individual has successfully passed a medical exam and is not otherwise ineligible, DHS will remove the conditional part of the Lawful Permanent Resident status.

(3) (U) The visa validity for Afghan SIV applicants whose medical exams are waived is six months from the date of visa issuance, unless the applicant is a child turning 21 years old, where the expiration is the child’s twenty-first birthday. Afghan SIVs issued without a valid medical exam must be classified as CQ-1, CQ-2, or CQ-3 and must also include the following case note: "The Deputy Secretary of State for Management and Resources and the Deputy Secretary of Homeland Security have exercised their joint authority to waive the medical exam for Afghan SIVs pursuant to Public Law No. 117-31, and the Chief of Mission has made a categorical determination that Afghan SIVs are unable to complete the required medical exam in Afghanistan in a timely manner without undue hardship or risk to personal safety. Post is proceeding with issuance without a medical exam based on this authority."

(4) (U) Afghan SIV applicants who already have valid medical exams should generally be processed according to the guidance in 9 FAM 302.2 for IV applicants with medical exams. If the consular section has a case that currently has a medical exam which has expired or will expire before flight, however, proceeding to issuance for these cases in the IVO system depends upon whether the medical exam is an eMedical case or a paper medical report.

(5) (U) For eMedical cases, the Med Exam date field will be protected and not editable. You should contact CA Service Desk to request the medical exam expiration date be set to a blank entry.

(6) (U) For paper medical reports, you should edit the Med Exam Expires field, leaving it blank so the applicant can be print authorized. On the Print Authorization window, the Med Expires date field will show “N/A”. The visa expiration will automatically be set to six months from print date, unless the applicant is a child turning 21 years old, where the expiration is the child’s twenty-first birthday.

(7) (U) For otherwise valid medical exams, no changes are needed, and applicants can travel with a valid medical report on the SQ-1, SQ-2, or SQ-3 classification code.

b. (U) NIV Applicants:

(1) (U) In General: Medical examinations are not routinely required for NIV applicants, except for K visa (fiancé) applicants.

(2) (U) Referring a Nonimmigrant to the Panel: You may require an NIV applicant to undergo a medical examination if you have reason to believe that the applicant may be ineligible for a visa under INA 212(a)(1). The NIV applicant must visit a panel physician in the country where the referring Embassy or Consulate is located.

(3) (U) Scope of the Examination: NIV applicants referred to a panel physician because of a suspected medical ground of ineligibility, including INA 212(a)(1)(A)(iii) or INA 212(a)(1)(A)(iv), must receive the same, full examination, as IV applicants, minus vaccination requirement.

c. (U) Medical Examination for K Applicants:

(1) (U) Vaccinations: Since applicants for K visas are essentially intending immigrants, a complete medical examination is required in every case. See 9 FAM 502.7-3(C)(3). As NIV applicants, K applicants are not subject to the INA 212(a)(1)(A)(ii) vaccination requirement. However, we and DHS have agreed that medical exams for K visa applicants should include the vaccination assessment as a matter of expediency. Therefore, you should make every effort to encourage K visa applicants to meet the vaccination requirements before admission to the United States. Nevertheless, you may not refuse K visa applicants for refusing to meet the vaccination requirements.

(2) (U) After the applicant is admitted to the United States in K status and applies for adjustment of status based on the relationship to the U.S. citizen named in the approved Form I-129-F, Petition for Alien Fiancé(e), DHS will use the panel physician's findings set forth on the Form DS-3025 to determine the applicant's admissibility on medical grounds. Where the applicant has fully met the vaccination's requirements of INA 212(a)(1)(A)(ii), as indicated on the Form DS-3025, no further action is required. Applicants who have not fully satisfied the vaccination requirements, however, will have to do so before they may finalize their adjustment of status in the United States (unless otherwise entitled to an individual or blanket waiver from DHS).

d. (U) Asylee Follow-to-Join (V-92 Beneficiaries): All asylee follow-to-join derivatives (Visa 92 (V-92) applicants) entering the United States must have the same medical examination as IV applicants have under INA 221(d) and 234. The medical examination for V-92 beneficiaries must be conducted by a panel physician. Like refugees, asylee follow-to-join beneficiaries are not required to meet the immunization requirements for immigrants until after one year when they apply for adjustment of status to become permanent residents in the United States.

e. (U) Refugees and V-93 Beneficiaries: All refugees and follow-to-join derivatives (Visa 93 (V-93) beneficiaries) entering the United States must have the same medical examination as IV applicants have under the INA 221(d) and INA 234. The medical examination for refugees may be conducted by a panel physician or by the International Organization for Migration (IOM). The U.S. Government pays the cost of refugee medical exams through the IOM. Unlike IV applicants, refugees, including V-93 beneficiaries, are not required to meet the immunization requirements for immigrants until one year after arrival, when they apply for adjustment of status to become permanent residents in the United States.

f. (U) Applicants Resident in the United States Applying Overseas: An individual who resides in the United States or who is present in the United States at the time of application but is applying for a visa overseas must receive a medical examination from a panel physician designated by the consular section at the overseas post. Such individuals may not submit a medical examination conducted by a civil surgeon in the United States.

9 FAM 302.2-3(B) (U) Purpose

(CT:VISA-1543; 05-17-2022)

a. (U) The purpose of the medical examination required under the provisions of INA 221(d) is to determine whether the applicant has a:

(1) (U) “Class “A”” condition—A medical condition that renders them ineligible to receive a visa; or

(2) (U) “Class “B”” condition—A medical condition that, although not constituting an ineligible condition, represents a departure from normal health or well-being that is significant enough to possibly:

(a) (U) Interfere with the applicant’s ability to care for himself or herself or to attend school or work; or

(b) (U) Require extensive medical treatment or institutionalization in the future.

b. (U) See 42 CFR Part 34 for the scope of the medical examination.

9 FAM 302.2-3(C) (U) Validity Period of an Applicant’s Medical Examination for Immigrant Visa Applicants

(CT:VISA-1796; 07-12-2023)

a. (U) Technical Instructions for Tuberculosis Screening and Treatment Using Cultures and Directly Observed Therapy: Medical examination validity is determined by the CDC. The following validity periods apply:

(1) (U) 6 Month Validity: No Class, a Non-TB Class condition, a Class B2 LTBI, and Class B3TB (Contact Evaluation), and all no-TB Class B conditions including Specific Class B conditions and Class B Other Conditions:

(2) (U) 3 Month Validity: Class “A” TB with a waiver (rare), a Class "B"0 Pulmonary, a Class “B”1 TB Pulmonary, or Class “B”1 TB Extrapulmonary, and HIV Infection (with or without a TB class).

(3) (U) Not Medically Cleared: If there was a finding of Class “A” TB and no waiver was granted the applicant is not medically cleared to travel until completion of successful treatment.

(4) (U) TB Technical Instructions Table:

	Medical Examination Validity Periods
CONDITION	Length of Validity for All Components of the Medical Exam	Medical Examination date that should be listed on Form DS-2054 or 7794	Examination Expiration Date That Should Be Listed on Form DS-2054 or 7794
· No Class (i.e., No apparent Defect, Disease or Disability) · Class A, Other than TB · Class B2 LTBI · Class B3 TB (Contact Evaluation) · Class B, all except TB, including: Specific Class B conditions & Class B Other conditions (Use 6 month validity except when any of the following is also present: Class A TB with waiver, Class B1 TB, or Class B Other for HIV Infection [see below]) · No HIV Infection	6 months1	Physical examination date	6 months from the examination date
· Class A TB with Waiver (rare) · Class B0 TB, Pulmonary · Class B1 TB, Pulmonary · Class B1 TB, Extrapulmonary · HIV infection3 (with or without a TB Class)	3 months2	Date final TB culture results reported by lab	3 months from date final TB culture results reported by lab

1 (U) If the TB portion of the examination has expired before immigration, the entire medical examination (all components, including vaccination, syphilis, mental health/substance abuse, etc. assessment) needs to be repeated at the same time the TB re-evaluation is performed. If the exam was completed with the paper forms, the expired DS forms should be submitted to the consular section along with the complete set of current DS forms for the new medical examination.

2 (U) If Class B1 TB, Extrapulmonary – Medical exam date listed on DS-2054 should be the date of the physical exam if cultures were not performed for extrapulmonary site. If culture results are obtained from extrapulmonary site, the medical exam date listed on DS-2054 or DS-7794 should be the date of final culture results reported by lab.

3 (U) Document HIV infection as “Class B1 TB, Pulmonary" on Form DS-2054 or DS-7794.

b. (U) Visa Validity: Notwithstanding the provisions of INA 221(c), you should make sure to limit the validity of the visa to the validity of the medical examination for all IVs except certain Afghan SIVs with medical exam waivers. For example, if an applicant has a medical examination that is only valid for four months from the time of visa issuance, the visa should be valid for only four months. If CDC approves an extension of the original medical examination validity, you should limit the visa to the new CDC-approved validity date, if the visa validity does not exceed six months and enter IVO case note: Medical Exam Expiration Extended by One Month per CDC Approval.

(1) (U) Visa Validity for Certain Afghan SIVs: On August 12, 2021, the Deputy Secretary of State for Management and Resources and the Deputy Secretary of Homeland Security jointly issued a blanket waiver of the requirement to undergo a medical exam before IV issuance or admission to the United States for certain Afghan SIV applicants who are in Afghanistan, who have met all requirements for SIV issuance other than the medical exam, and for whom the Chief of Mission has determined are unable to complete the required medical exam in a timely manner without undue hardship or risk to personal safety. The visa validity for Afghan SIV applicants whose medical exams are waived is six months from the date of visa issuance, unless the applicant is a child turning 21 years old, where the expiration is the child’s twenty-first birthday.

c. (U) New Medical Examinations: Applicants not traveling to the United States within the exam validity period will need to undergo a new medical examination unless CDC has approved an extension of the original medical examination validity. If the TB portion of the examination has expired before immigration, the entire medical examination (all components, including vaccination, syphilis, mental health/substance abuse, etc. assessment) must be repeated at the same time the TB re-evaluation is performed. If the exam was completed with the paper forms, the expired DS forms should be submitted to the consular section along with the complete set of current DS forms for the new medical examination.

9 FAM 302.2-3(D) (U) U.S. Department of Health and Human Services , Centers for Disease Control and Prevention (HHS/CDC) Regulations Governing Medical Examinations

(CT:VISA-1543; 05-17-2022)

(U) CDC regulations relating to medical examinations of applicants are contained in 42 CFR Part 34. For specific instructions for performance of medical examinations see Technical Instructions (TIs) for Panel Physicians, the Tuberculosis (TB) TIs, TIs for Vaccinations, and all other TIs available on CDC's panel physician portal on their website. Each panel physician should have their own personal copy of these instructions.

9 FAM 302.2-3(E) (U) Panel Physicians

9 FAM 302.2-3(E)(1) (U) Role of Panel Physicians

(CT:VISA-2008; 06-11-2024)

a. (U) Medical Examinations: The panel physician is responsible for the entire examination. The examination must include:

(1) (U) a medical history;

(2) (U) an immunization history and the administration of any required immunizations (for IV applicants);

(3) (U) a physical examination;

(4) (U) a mental examination;

(5) (U) a full-size chest radiograph;

(6) (U) a serologic test for syphilis (for applicants ages 18-44 or if the panel physician finds there is a reason to suspect infection);

(7) (U) a laboratory test for gonorrhea (for applicants aged 18-24 or if the panel physician finds there is a reason to suspect infection);

(8) (U) sputum smears and cultures if signs/symptoms of tuberculosis are detected or known HIV infection;

(9) (U) a report of the results of all required tests and consultations;

(10) (U) verification that the completed medical report forms are sent directly to you; and

(11) (U) verification that the person appearing for the medical examination is the person applying for the visa.

b. (U) Authority: The panel physician does not have the authority to determine whether an applicant is eligible for a visa. You make that determination after reviewing all the records, including the report of the medical examination.

9 FAM 302.2-3(E)(2) (U) Selection of Panel Physicians

(CT:VISA-2008; 06-11-2024)

a. (U) In General: The Department has regulatory authority over the selection of panel physician(s). CDC's Division of Global Migration Health, in collaboration with CA/VO oversees and monitors panel physician activity. While there are no specific regulations governing the selection or termination of panel physicians, you must notify CA/VO/F and CDC before adding or removing panel physicians. CDC has provided guidelines on how to select a panel physician. See 9 FAM 302.2-3(E)(2) paragraph e. CDC recommends that when selecting panel physicians, you seek the advice of the local medical community, medical associations in the area, and any U.S. government physicians who may be available locally. Consular sections must have current written agreements with panel physicians. See 9 FAM 302.2-3(E)(3) paragraph b, for text of Sample Physician Written Agreement and 9 FAM 302.2-3(E)(3) paragraph f(7), Overall Review of Performance.

b. (U) Criteria for Appointment of Panel Physicians: CDC recommends that the following criteria be applied, when possible, in the appointment of panel physicians:

(1) (U) The physician must have satisfactorily completed medical education and have a medical degree from an accredited medical school;

(2) (U) The physician should have special competence in the diagnosis and treatment of individuals with tuberculosis and sexually transmitted illnesses (STIs) and should be able to recognize mental illness;

(3) (U) The physician should have demonstrated competence to perform large numbers of examinations for specific purposes, such as insurance, industrial employment, etc. (this point is less important for a consular section where there are a limited number of medical examinations);

(4) (U) The physician should have reliable X-ray facilities or access to such facilities and should be able to arrange for laboratory work to be performed by a laboratory of recognized competence; and

(5) (U) The physician should have reliable storage facilities or have access to such facilities for vaccines, according to the CDC’s Technical Instructions for Vaccinations. Proper handling and storage of vaccines are important to ensure their potency.

(6) (U) See 9 FAM 302.2-3(E)(3) paragraph f for in-depth guidance on selecting a panel physician and monitoring the IV Medical Exam.

c. (U) Small Number of Panel Physicians with Convenient Offices: You should limit the number of examining physicians to the minimum number needed to manage the volume of applicants. For panel physicians to develop expertise, they should examine at least 2,000 applicants where volume allows. Consular sections with an IV volume under 2,000 applicants may have a second panel physician to provide choice and as back-up. You may approve additional panel physicians, if necessary, based on local circumstances in consultation with VO and CDC. To minimize possible fraud and for better communications with the examining physician, it is best to have the physician’s examining facility located near the consular section. You may approve additional locations in other parts of your consular district where a significant number of applicants live in consultation with CDC and VO if you are able to complete the required annual inspection.

d. (U) Use of Hospital Physicians for Examinations: When you use the facilities of a hospital with a large turnover of doctors, you should still limit the number of panel physicians to the smallest number needed to manage that volume. All examining panel physicians must sign the agreement.

e. (U) Consultations with the CDC and the Visa Office on Panel Physician Appointments and Terminations:

(1) (U) Communicate with the CDC (cdcqap@cdc.gov) and the panel physician portfolio holder in CA/VO/F when considering the addition of a panel site or physician, although final authority rests with the consular chief.

(2) (U) Communicate with the CDC (cdcqap@cdc.gov) and the panel physician portfolio holder in CA/VO/F before the termination of a panel site or physician, although final authority rests with the consular chief.

(3) (U) CDC may recommend that a consular section either terminate or not renew an existing panel physician agreement for cause. Such a request will be addressed to both the consular section and CA/VO/F. The consular section must communicate in writing to the cdcqap@cdc.gov mailbox and CA/VO/F within 45 days of the date of the written report, indicating whether it will terminate or continue the agreement of the panel physician.

(4) (U) You are reminded to include the address "CDC ATLANTA GA" with pass line "CDC FOR CDC/DGMH" on any cable associated with panel physician issues.

9 FAM 302.2-3(E)(3) (U) Contact with Panel Physicians

(CT:VISA-2008; 06-11-2024)

a. (U) Introductory Visit to the Panel Physician: If possible, you should pay an introductory call on each panel physician at the physician's office. During the visit, you should ensure that the physician is thoroughly familiar with the CDC's Technical Instructions including Medical History and Physical Examination; Mental Health; Vaccinations; Gonorrhea; Tuberculosis; Syphilis; Hansen's Disease (Leprosy); Other Physical or Mental Abnormality, Disease, or Disability; and any CDC published updates, and is performing examinations in strict compliance with CDC instructions. You should review proper procedures for establishing the identity of persons being tested. You should also inspect the laboratory facilities and review prescribed procedures for ensuring the proper control of X-rays and blood samples. See 9 FAM 302.2-3(E)(3) paragraph f below.

b. (U) Visiting Outside Laboratories: If the panel physicians use outside laboratory facilities, you should require them to keep the total number of labs to a minimum; we suggest no more than three per country. Where feasible, panel physicians should oversee the drawing of the blood samples to limit risk of substitution. You and panel physicians should also visit outside labs on a periodic basis to ensure that proper identification safeguards and good laboratory procedures are being followed. Finally, you should emphasize the necessity of the physician personally contacting the officer in the event of a Class A finding in any applicant.

c. (U) Follow-Up Contacts: You should maintain periodic contact with the panel physicians, and should, if possible, make occasional, unannounced visits in addition to the required annual inspection. You should occasionally ask IV applicants to describe the scope of the medical examination they received, the procedures used to establish identity, and the arrangements for pick-up of the medical reports. You should discuss any lax or improper procedures with the panel physician.

d. (U) Group Sessions: Where workload and logistics permit, you may host group meetings, which involve all panel physicians. Such meetings give panel physicians the opportunity to share notes and raise any current problems or issues which they may wish to discuss.

e. (U) Panel Physician Agreements:

(1) (U) Upon assuming duty as an IV unit chief (or chief of a small consular section), you should review all existing panel physician agreements to verify that they are valid and conform to suggested standard language (see below). A copy of each agreement should have been sent to CDC via email at cdcqap@cdc.gov and CA/VO/F.

(2) (U) Sample Written Agreement: Use the most recent sample panel physician agreement obtained by clicking on Panel Physician Agreement anywhere it appears in the FAM to open an editable and printable word version of the document.

f. (U) How to Select a Panel Physician and Monitor the Medical Examination for IVs:

(1) (U) Panel physicians, under agreement with the consular section of the embassy or consulate, conduct the medical examination of U.S.-bound immigrants and refugees.

(2) (U) Standard criteria should be used in determining if a physician has adequate training and/or experience to be a panel physician. An agreement of 1-year duration is signed between the consular section and the physician for their services for that period. The termination of a panel physician should occur when due cause is found. You should maintain a good relationship with the panel physician. This usually occurs by periodic visits to their facility or telephone communication. At least once a year, you must perform an evaluation of all the components of the medical examination, including the panel physician.

(a) (U) Standard Criteria for Panel Physicians:

(i) (U) Make sure the need for such a physician exists. The number of examining panel physicians must be kept to a minimum. It is recommended that each panel physician conduct at least 2,000 visa applicant examinations, if volume allows.

(ii) (U) The panel physician must speak and write in English.

(iii) (U) The panel physician should submit a résumé or CV, showing satisfactory completion of medical education and a medical degree from a national government accredited medical school.

(iv) (U) The panel physician should have a full local license with no restrictions that they have used for the past 4 years.

(v) (U) The panel physician should have an official governmental certificate of good standing, or the equivalent, in the medical profession, if available in the country where the physician has their license.

(vi) (U) You should obtain, two independent professional references provided by the physician.

(vii) (U) You should follow-up on these independent professional references with verbal contact to one of the references before the appointment of the panel physician.

(viii) (U) In selecting a panel physician, you should seek the advice of the local medical community, medical associations, and any U.S. Government physicians in the area.

(ix) (U) The panel physician appointment is person and location specific. If the physician moves, the appointment is reviewed rather than automatically being transferred. A need for the physician's services must exist.

(x) (U) If another physician acts of behalf of the panel physician, the final responsibility of exam results lies with the panel physician.

(xi) (U) A sample signature must be given to you to keep on file to periodically assess for fraud.

(xii) (U) The panel physician must be available for a minimum of 46 weeks out of 52 weeks a year. Any absence of greater than 2 weeks requires notification to the consular section with the recommendation of a physician to take over emergency duties during the absence of the panel physician.

(xiii) (U) Information about the stand-in physician's qualifications must be provided to you.

(b) (U) Medical Requirements:

(i) (U) The panel physician should be adept in primary care (pediatrics, internal medicine, or family medicine) and have specialty training or experience after graduating from medical school. Some countries do not have residency programs; therefore, on-the-job training must suffice. The panel physician must have specific competence in the diagnosis and treatment of individuals with tuberculosis and sexually transmitted diseases and should be able to recognize mental disorders.

(ii) (U) The panel physician should identify a psychiatrist or mental health specialist, if possible, for the referral of any individual who appears to have a mental disorder.

(iii) (U) The panel physician should have reliable radiology (X-ray) and serology (syphilis laboratory) facilities identified. These can either be on the premises or contracted out.

(iv) (U) Specialty training in pediatrics is desired for consular sections with large volumes of international adoptee cases.

(v) (U) The panel physician should have accumulated 4 years in practice after their internship training is completed. Less than 4 years in practice would mean a probation period would be established before full panel physician status would be bestowed.

(vi) (U) The panel physician must agree to participate in quality control surveillance.

(i) (U) The facility must be acceptable; it should be at a minimum a well-lit facility with an examination table, a blood pressure cuff, instruments to examine the eyes and ears (ophthalmoscope and otoscopy), and an eye chart (at 20 feet).

(ii) (U) Email or fax communication capabilities identified by the panel physician is highly desirable.

(iii) (U) Internet access is required so the panel physician can use eMedical for all eMedical-eligible IV cases.

(iv) (U) Examinations must be given within 10 working days of the date that is asked for by the applicant.

(v) (U) The panel physician must be able to verify the identity of each applicant and use fraud prevention measures at every step in the process (at time of blood draw [phlebotomy], X-ray, vaccine administration, and sputum collection).

(vi) (U) Where possible and the number of visa applicants warrant two or more, panel physicians should be of both sexes at every location.

(3) (U) Removal Standards for Panel Physicians:

(a) (U) Panel Physicians can be removed for due cause (such as misconduct, fraud, loss of license, and criminal conviction). This would result in the immediate loss of appointment as panel physician. Short of this, you are encouraged to consider additional training and counsel the panel physician in areas that are deficient.

(b) (U) Any complaint against a panel physician must be investigated by you. Notify CA/VO/F and the Division of Global Migration Heath of the Centers for Disease Control and Prevention (CDC/DGMH). Advise CA/VO/F in Washington, DC and CDC/DGMH via cdcqap@cdc.gov before notifying the panel physician of any action you plan to take.

(c) (U) If you decide you no longer wish to continue the relationship with the panel physician but do not have due cause to remove the panel physician, you can either wait until the yearly time limit on the panel physician agreement expires, then notify the panel physician that their services will not be continued by the embassy/consulate or give 30 days' notice as noted in the panel physician agreement. For either option, notify CA/VO/F in Washington DC and CDC/DGMH via cdcqap@cdc.gov before notifying the panel physician.

(4) (U) Maintenance of the Appointment for a Panel Physician:

(a) (U) Renew the written agreement annually, usually every October 1st.

(b) (U) Check that there is a current full local license with no restrictions.

(c) (U) Check that there is a current official governmental certificate of good standing, or equivalent, in the medical profession, if available in the country where the physician has their license.

(5) (U) The Components of the Medical Examination, which should be Evaluated by You are:

(a) (U) The Panel Physician’s Contact with the Applicant, Consisting of Collecting Past Medical History and Performing a Physical Examination;

(b) (U) Determining Vaccination History and Administering Vaccines, if Necessary;

(d) (U) Testing for Syphilis (for applicants ages 18-44 or if the panel physician finds there is a reason to suspect infection);

(e) (U) Testing for Gonorrhea (for applicants ages 18-24 or if the panel physician finds there is a reason to suspect infection);

(f) (U) Taking Chest X-Rays;

(g) (U) Collecting Sputum Samples, if necessary;

(h) (U) IGRA for children in high burden countries; and

(i) (U) Microscopy Testing for Tuberculosis (TB).

(6) (U) Evaluating the Panel Physician and Panel Site:

(a) (U) You should consider three elements in your evaluation of each of the components of the Medical Examination for an IV:

(i) (U) Fraud Prevention Measures taken;

(ii) (U) Reliability and Quality of the various components; and

(iii) (U) Safety Measures taken while conducting the component, or Education provided to the applicant.

(b) (U) The following methods are the proposed ideal by the CDC for fraud prevention measures by the panel physicians or their staff, the laboratory directors or their staff, or the radiologists or their staff during the medical examination process:

(i) (U) Verifying the applicant’s identity by comparing the person with an official document that contains the applicant’s photograph (such as a passport or official government issued identification card).

(ii) (U) Verifying the applicant’s signature by comparing a sample signature with one from an official document containing their signature.

(iii) (U) Panel physicians should upload or take a photo of applicants at the time of the exam for eMedical cases. Applicants with paper forms should present four recent passport photos. The panel should still confirm the likeness of the applicant with official documents (typically a passport).

(7) (U) Overall Review of Performance: For the annual Consular inspection of the panel site, use sample Review of Performance by clicking on Review of Performance anywhere it appears in the FAM to open an editable and printable word version of the document.

9 FAM 302.2-3(F) (U) Medical Examination and Findings

9 FAM 302.2-3(F)(1) (U) Fee for Medical Examination

(CT:VISA-1979; 04-25-2024)

(U) The fees charged for the medical examination, chest x-rays, vaccinations, and serological tests are determined by you and the selected physician and should be based on prevailing medical fees charged within the country for similar services. You can consult the Embassy/Consulate health unit to learn about local medical fees. The price of a medical exam should not change during the validity period of the current panel physician agreement.

9 FAM 302.2-3(F)(2) (U) Medical Screening Forms

(CT:VISA-2008; 06-11-2024)

a. (U) Required Forms: The panel physician must complete the following forms for all visa applicants referred to them for visa medical examinations:

(1) (U) Paper-based Collection:

(a) (U) Form DS-2054, Report of Medical Examination by Panel Physician;

(b) (U) Form DS-3030, Tuberculosis Worksheet;

(d) (U) Form DS-3026, Medical History and Physical Examination Worksheet.

(2) (U) Electronic Collection (eMedical): Form DS-7794; If a case is available in eMedical, the exam must be completed in eMedical. You can ask the panel physician to re-do the report if an eMedical-eligible case was completed on paper forms.

b. (U) Nurses and Authorized Staff: A nurse or other authorized staff may complete the forms on behalf of the panel physical. The panel physician, however, must review and sign the forms and make the determination as to whether the applicant meets all necessary medical requirements or if the applicant should seek a waiver.

c. (U) Providing Copies: You can review and download paper forms from e-Forms. You should email fillable PDF versions of the paper forms for panel physicians to complete electronically. CCD requires that panel physicians type all forms. Panel physicians will access the eMedical collection through the eMedical website.

d. (U) Medical Examination Report: All completed forms and any related worksheets should be provided to you as the panel physician’s medical examination report for each applicant.

e. (U) Form DS-2054, Report of Medical Examination by Panel Physician: Ensure that a panel physician has recorded the results of medical examinations on Form DS-2054, and related worksheets. The panel physician must complete this form for any applicants receiving a medical examination, including NIV applicants.

(1) (U) Form DS-2054, is essential for immigrant applicants or refugee resettlement. It should be used consistently and always be included in the immigrant or refugee packet. Form DS-2054 is used to establish eligibility under INA 212(a)(1). You are responsible for ensuring that the physician has filled out all the information at the top of the form.

(2) (U) If a Class A condition is found, determine which Class A condition(s) applies to the IV applicant and whether a waiver under INA 212(g) is applicable. (If a refugee is found to have a Class A condition, you should seek the assistance of Bureau of Population, Refugees and Migration/Office of Admissions (PRM/A) or follow guidance on waiver processing for refugees.) If the Class A condition is non-TB, the medical exam is only valid for six months (with waiver). In the case of Class A TB condition with a waiver, the medical exam is only valid for three months from the date of the final TB culture results. You should inform the visa applicant of the time frame validity of the medical exam and the requirement that they must get a new medical examination if they do not depart for the United States within the validity period of their exam. Class A waivers for tuberculosis or mental disorders should be annotated on the Machine Readable Immigrant Visa (MRIV) to reflect the applicant’s condition for CDC. See 9 FAM 504.10-3(B)(1).

(3) (U) If a Class B condition is found in the case of IV applicants, the box in "Class B Conditions” is checked, and you should annotate the MRIV. See 9 FAM 504.10-3(B)(1). You should also determine if there are any public charge issues. If there are not, the visa process can continue. If there is a Class B2 TB or Class B3 TB condition, the medical exam is valid for six months. In cases involving a Class B0 TB Pulmonary, Class B1 TB Pulmonary, or Class B1 TB Extrapulmonary condition, the medical exam is only valid for three months. You should inform the visa applicant of the time frame validity of the medical exam and the requirement to get a new medical exam if they do not depart for the United States within the validity period of the examination.

f. (U) Form DS-3030, Tuberculosis Worksheet: Form DS-3030 is designed for the physician's use in diagnosing a tuberculosis (TB) condition and classification. The panel physician should ascertain fraud prevention measures in collecting information. The panel physician should ascertain that fraud prevention measures for applicant identity verification and information collection are taken by outside x-rays labs to which applicants are referred. See 9 FAM 302.2-3(F)(5).

g. (U) Form DS-3025, Vaccination Documentation Worksheet: Form DS-3025 provides a list of immunizations needed by the applicant as required by law. A copy of the vaccination worksheet must be provided to the applicant.

h. (U) Form DS-3026, Medical History and Physical Examination Worksheet: Form DS-3026 includes information regarding past medical history as reported by the applicant and recorded by the panel physician or by other qualified medical personnel. Rules concerning the requirements of medical history and medical examination can be found in the Technical Instructions and in the panel physician agreement. See 9 FAM 302.2-3(E)(2) paragraph e(4). This form should be reviewed by you to determine whether an additional medical condition would raise public charge issues. (Public charge concerns are not applicable to refugee applicants.)

i. (U) Form DS-7794, Electronic Medical Examination: Form DS-7794 is the PDF produced by the eMedical system upon completion of a health case. It collects the same data as the paper collection, but in a different format.

(1) (U) eMedical divides the medical examination into individual exams. Depending on the applicant's age and individual health, you can expect to see some or all the following exams. You will find the expiration date and classification on the first page. You should follow the same steps in 9 FAM 302.2-3(F)(2) paragraph e to check for visa ineligibilities, medical exam validity, and the need for annotations or waivers.

(a) (U) 501: Medical Examination;

(b) (U) 502: Chest X-ray Examination;

(d) (U) 607: Continued anti-tuberculosis treatment;

(e) (U) 712: Syphilis test (for applicants ages 18-44 or if the panel physician finds there is a reason to suspect infection);

(f) (U) 713: Gonorrhea test (for applicants aged 18-24 or if the panel physician finds there is a reason to suspect);

(g) (U) 714: Hansen's Disease;

(h) (U) 719: TB Screening test - TST or IGRA;

(i) (U) 951: Vaccinations; and

(j) (U) 106: Mental health report.

(2) (U) Interim Reports: Most applicants who are diagnosed with Class A TB will seek a waiver or undergo treatment to proceed with their visa adjudication. In the paper form context, panel physicians are required to notify consular sections of Class A diagnoses and send completed paper forms documenting the classification. In the eMedical context, panel physicians are still required to notify the consular section of any Class A diagnoses but for applicants with Class A TB, pulmonary, who elect to undergo treatment, the health case remains open in eMedical during the treatment period so the consular section will not receive a copy of the final DS-7794 until treatment is complete and the applicant is re-classified as Class B0 TB, pulmonary. To document the Class A TB, pulmonary, diagnosis, the system sends an "interim report" to EDP documenting the positive sputum result and/or clinic diagnosis of active pulmonary TB. This report does not list a classification nor does it list an expiration date. You should take care not to issue the visa based on the "interim report" but instead enter the appropriate 1A1 refusal in CLASS if the application has been executed or a P1A1 quasi-refusal if the application has not been properly made and executed and wait for the final DS-7794 that contains a classification and expiration date.

9 FAM 302.2-3(F)(3) (U) Basis for Medical Report in Determining Eligibility

(CT:VISA-1543; 05-17-2022)

a. (U) In General: The panel physician conducts the examination and testing required to assess the applicant’s medical condition and then completes Form DS-2054, Form DS-3030, Form DS-3025, and Form DS-3026 or eMedical Form DS-7794. The panel physician determines whether diagnostic tests are needed when the medical condition is self-described by the applicant.

b. (U) The Report: Upon completion of the applicant’s medical examination, the examining physician must submit the report to you. The report must include the results of any diagnostic tests required for the diagnosis of the diseases identified as communicable diseases of public health significance and any other tests necessary to confirm suspected diagnoses of any other Class A or Class B condition. You will see the list of results on the form as follows:

(1) (U) No apparent defect, disease, or disability;

(2) (U) Class A—a communicable disease of public health significance; IV applicant vaccination refusal; a physical or mental disorder with harmful behavior; or addiction abuse of specific substance on the CSA.

(3) (U) Class B—physical or mental defect, disease, or disability serious in degree or permanent in nature amounting to a substantial departure from normal physical or mental well-being.

c. (U) Report Necessary for Finding: You may not find an applicant ineligible under INA 212(a)(1) without a report from the panel physical.

9 FAM 302.2-3(F)(4) (U) Effect of Findings

(CT:VISA-2008; 06-11-2024)

a. (U) Class A Findings:

A “Class “A”” medical finding requires you to find an applicant ineligible under INA 212(a)(1). The physician’s examination must be conducted in accordance with the current Technical Instructions.

b. (U) Class B Findings: A Class B medical finding informs you that a serious medical condition exists which constitutes a departure from normal health or well-being. Consider such finding when assessing the eligibility for visa issuances; i.e., the likelihood of the applicant becoming a public charge.

9 FAM 302.2-3(F)(5) (U) Precautions in Establishing Identity of Visa Applicants Undergoing Medical Examinations

(CT:VISA-2008; 06-11-2024)

a. (U) Verifying Identity of Person Examined: Ensure that panel physicians take every possible safeguard to verify that the person who is examined by the physician is, in fact, the visa applicant. Appropriate steps must be taken to preclude the substitution of persons at medical examinations as well as other fraud.

b. (U) Physicians' Responsibilities Regarding Applicant's Identity:

(1) (U) You should provide instruction sheets to the applicant outlining the medical examination requirements and procedures and should instruct the applicant that they must present these instructions and their passport to the panel physician at the time of the medical examination.

(2) (U) The instruction sheets must convey to the examining physician the need for careful comparison of the identity of the visa applicant with the photograph attached to the applicant passport or with other documents of identity to prevent potential fraud. Instruction sheets must also include a requirement that the physician endorse Form DS-2054 or Form DS-7794.

c. (U) X-Ray and Other Medical Documents to Refer to Specific Applicant by Name: Reports of serological or other tests, particularly the chest x-ray, must include the name of the applicant examined to prevent document substitution. This requirement applies to all images, regardless of format. As of October 1, 2014, the only CDC acceptable format for chest radiograph is digital radiographs. For applicants whose case is available in eMedical, panel physicians must submit the digital x-ray image by uploading it to the 502 exam in eMedical in DICOM (.dcm) format. Panel physicians are not required to provide eMedical applicants with copies of their x-rays on CDs unless the applicant requests it. Panel physicians must continue to provide a copy of the x-ray on a CD to applicants whose medical examination is completed using the paper forms. You should instruct the panel physician(s) to follow the procedure set forth in 9 FAM 302.2-3(F)(5) paragraph b above when they refer a visa applicant to another physician or to a laboratory for an x-ray examination or laboratory tests. Also instruct the physician or laboratory to which the applicant is referred to take similar care in establishing the visa applicant’s identity on all documentation.

9 FAM 302.2-3(F)(6) (U) Chest X-Rays and X-Ray Requirement for Applicants under 15 years old and Pregnant Women

(CT:VISA-1979; 04-25-2024)

a. (U) Applicants Under 15 Years Old: In most cases, CDC regulations provide that a chest x-ray examination should not be required if the applicant is under the age of 15. However, applicants under the age of 15 whose country has a tuberculosis incidence rate greater than or equal to 20 per 100,000, are ill and have signs or symptoms suggestive of tuberculosis or who are a known contact of someone diagnosed with tuberculosis must be screened using an Interferon Gamma Release Assay (IGRA) test. If no FDA-approved IGRA test is licensed for use in the country where the consular section is located, panel physicians must screen using a tuberculin skin test (TST). A chest x-ray (CXR) examination may be required, depending on the result of the TST. Applicants under 10 years of age who receive a CXR should have a standard view and lateral view images. If the applicant has a CXR with findings suggestive of tuberculosis, the applicant must provide three sputum specimens to undergo microscopy for acid-fast bacilli, as well as cultures for mycobacteria and confirmation of the Mycobacterium species (in accordance with the current TB TIs).

b. (U) Pregnant Women:

(1) (U) CDC requires that women who are pregnant and required to have a medical examination in connection with the issuance of a visa have a chest x-ray examination.

(2) (U) Applicants who are pregnant may postpone the required immigration chest x-ray (and immigration medical examination) until after pregnancy but are required to have a chest x-ray to immigrate. If panel physicians choose to obtain consent from pregnant women for the chest x-ray, they should develop their own consent form. Lead shielding practices for applicants should follow applicable local laws and regulations; however, lead shielding is no longer recommended or required for the immigration medical examination for any applicants, including those who are pregnant.

9 FAM 302.2-3(F)(7) (U) Referral of Doubtful Cases to Local Specialist and Centers for Disease Control

(CT:VISA-2008; 06-11-2024)

a. (U) Cases to be Referred Locally if Possible: Since CDC does not currently have physicians stationed abroad to whom panel physicians may refer doubtful cases, you should inform local panel physicians that whenever further medical consultation is deemed advisable, the applicant should be referred to an appropriate local specialist at the applicant’s expense. Under generally accepted medical procedures, the specialist should report the findings and opinion to the panel physician who remains responsible for the completion of Form DS-2054, Form DS-3026, Form DS-3030, and Form DS-3025, or Form DS-7794, and results of the medical examination.

b. (U) Referral to the CDC in Rare Instances:

(1) (U) In those comparatively rare instances where no local specialist is available for consultation, local panel physicians shall refer specific problems to CDC at cdcqap@cdc.gov.

(2) (U) In submitting medical questions relating to diseases of the chest, the panel physician should furnish the following:

(a) (U) A complete medical history including history of the clinical course of the disease;

(b) (U) Bacteriological studies (AFB smears or culture results);

(d) (U) Detailed account of treatment (chemotherapy and other); and

(e) (U) Organism resistance studies, if done.

(3) (U) If the problem relates to mental illness, the panel physician should furnish the following information:

(a) (U) A complete medical history of the applicant, including details of any hospitalization or institutional care or treatment for any physical or mental condition;

(b) (U) Findings as to the current physical condition of the applicant, including reports of chest X-ray examination and of serologic testing for syphilis infection if the applicant is between 18-44 years old , and other pertinent diagnostic tests; and

(c) (U) Findings as to the current mental condition of the applicant, with information as to prognosis and life expectancy and with a report of a psychiatric examination conducted by a psychiatrist who, in case of intellectual disability, shall also provide an evaluation of intelligence.

(4) (U) For an applicant with a history of mental illness, the medical report must also contain information on which the CDC can base a finding as to whether the applicant has been free of such mental illness for a period sufficient in the light of such history to demonstrate recovery.

c. (U) Confidentiality of Reports Received from CDC: Consular sections receiving reports from the CDC in response to direct requests for review may inform inquirers for this review that the report has been received but may furnish additional information only as consistent with the requirements of INA 222(f) concerning the confidentiality of records pertaining to the issuance or refusal of visas.

9 FAM 302.2-3(F)(8) (U) Divulgence of Contents of Medical Examination Reports

(CT:VISA-2008; 06-11-2024)

(U) Follow the guidance in 9 FAM 603.2-3 in responding to inquiries on individual visa cases and grounds of visa ineligibility for medical reasons. You should not divulge the details of an applicant’s general physical and mental health. The inquirer should be told only that the applicant has been found to be medically qualified for a visa. The inquirer should be referred to the visa applicant for further information. Neither consular section nor panel physicians may provide copies of the completed DS medical forms to the applicants or other interested parties because they are visa records and confidential under INA 222(f), but panel physicians may share their own records in the form of lab reports and similar documentation with the applicant upon request. Panel physicians should share a copy of the record of vaccination with the applicant if vaccinations were given during the immigration medical exam (see 9 FAM 302.2-3(F)(11)).

9 FAM 302.2-3(F)(9) (U) Delivery of Medical Reports to Consular Section After Medical Examination

(CT:VISA-1543; 05-17-2022)

a. (U) For cases completed on paper medical forms, in which no Class A or Class B TB medical condition is detected, the panel physician may give the paper medical reports in a sealed envelope to the applicant to take to the interview. For cases completed using the DS-7794, the eMedical system will transmit the DS-7794 directly to eDP.

b. (U) In cases in which a Class A medical condition is detected, the panel physician must not give the medical report to the applicant but shall ensure that it is delivered directly to the consular section, except in rare instances when the physician must give the report to the applicant to deliver to the consular section. In those rare instances in which it is necessary for the applicant to take the medical report to the consular section, the panel physician must ensure that the report is placed in a sealed envelope in such a way that you can easily determine if it has been opened. Panel physicians must also notify the consular section immediately if applicants are found to be Class A and/or referred to sputum testing. This notification requirement applies to applicants with eMedical and paper medical forms.

c. (U) In cases in which a Class B TB medical condition is detected and the exam is on paper medical forms, the panel physician must not give the medical report to the applicant but must ensure that it is delivered directly to the consular officer, except in cases in which the procedure is impractical. In those rare instances in which it is necessary for the applicant to take the medical report to the consular officer, the panel physician must ensure that the report is placed in a sealed envelope in such a way that the consular officer can easily determine if it has been opened.

9 FAM 302.2-3(F)(10) (U) Delivery of Medical Documents After Visa Issuance to Applicants with and without Class A or B Medical Conditions

(CT:VISA-2008; 06-11-2024)

a. (U) Packet Requirements:

(1) (U) MIV cases with eMedical Form (DS-7794): Applicants with MIV cases and Afghan SIV applicants whose medical examinations were processed in eMedical do not need to physically carry medical forms to the United States, but ensure that the DS-7794 is uploaded in EDP. You should continue to annotate IV and K visas for all medical conditions except "No Class" and "Class B Other".

(2) (U) MIV cases and Afghan SIV cases with Paper Forms (DS-2054, DS-3025, DS-3026, DS-3030): The consular section must scan or upload electronic versions of the DS-2054 and other paper medical forms into eDP for MIV applicants whose medical exam was completed on paper forms. If the applicant has a Class A or Class B condition (except Class B other), applicants must hand-carry a skinny packet with a single copy of each paper form (DS-2054, DS-3025, DS-3026, DS-3030) in a sealed envelope with the Immigrant Data Summary Page attached to the envelope. If provided, return CDs containing x-ray images to the applicants and instruct them to maintain them for their medical records. You should continue to annotate IV and K visas for all medical conditions except "No Class" and "Class B Other".

(3) (U) IVIS Cases with eMedical Exam (DS-7794): Consular sections must include a printed copy of the DS-7794 in the paper IV packet for applicants with legacy IVIS cases whose medical examinations were processed in eMedical.

(4) (U) IVIS Cases with Paper Exam (DS-2054, DS-3025, DS-3026, DS-3030): Ensure that at least the original of each form is in the paper visa packet. Include the original and three copies for applicants with Class A or Class B conditions (except Class B other). If an applicant has a Class A or Class B Medical Condition, except for "Class B Other" conditions, at the time of visa issuance, attach, by staples, to the Immigrant's Data summary page a sealed envelope containing the original and three copies of Form DS-2054 and all related worksheets with two heavy-duty staples in the upper left corner of Summary Page, well above the space for the applicant's name so as not to obscure the name. When attaching an envelope containing medical forms, you should ensure that staples do not go through the documents inside the envelope. Visa staff must assemble individually the visas of members of a family group; they must not be attached together with staples. U.S. Customs and Border Protection (CBP) will collect the original form and give two copies to the CDC Quarantine Station, which will keep one copy and send the other to CDC Headquarters. The envelope must be clearly marked “Medical Report (Form DS-2054 and related worksheets) enclosed.” Give to the applicant all available x-ray image(s) (in a CDC accepted format) pertaining to the case in a separate sealed envelope.

b. (U) Required Annotations:

(1) (U) IV Applicants: Annotate an IV or fiancé visa as indicated in the following cases:

(a) (U) When the medical examination has revealed a Class A medical condition and an INA 212(g) waiver has been granted, the visa must be annotated. See 9 FAM 504.10-3(B)(3).

(b) (U) When the medical examination has revealed a Class A or Class B condition other than Class B other, the visa must be annotated with "Class A or Class B req. ATTN of USPHS at POE."

(2) (U) NIV Applicants: A NIV must be annotated as indicated in the following cases:

(a) (U) When the medical examination has revealed a Class A tuberculosis or another Class A medical condition, and an INA 212(d)(3)(A) waiver has been granted, the visa must be annotated: "MED: 212(d)(3)(A)".

(b) (U) When the medical examination has revealed a Class B tuberculosis condition or Class B leprosy, non-infectious, the visa must be annotated: "MED: Class B".

9 FAM 302.2-3(F)(11) (U) Immigrants Advised to Carry Immunization and Other Records to United States

(CT:VISA-1543; 05-17-2022)

a. (U) Every state in the United States requires that children have a record of completed immunization(s) at the time of a child’s first enrollment into school. In most states, this applies to transfer students entering any grade. Therefore, the CDC strongly recommends that children entering the country should either have evidence of immunity consisting of physician documentation of prior disease or a record of immunizations.

b. (U) Panel physicians must inform IV applicants at the time of examination that problems may be encountered should they enter the United States without proper health records and certifications of vaccinations, and they must urge the applicants to obtain such documents from their private physicians, local health departments, or schools before departure.

c. (U) Panel physicians must provide a copy of Form DS-3025 to all immigrants as part of their permanent health record. Immigrants should be advised to hand-carry this document with their other medical paperwork.

9 FAM 302.2-3(G) (U) Basis of Medical Report in Determining Ineligibility Under Public Charge - INA 212(a)(4)

(CT:VISA-2008; 06-11-2024)

a. (U) In addition to the examination for specific ineligible conditions, the examining physician must also look for other physical and mental abnormalities that suggest the applicant is likely to become a public charge.

b. (U) When identifying a “Class “B”” medical condition that may render the applicant ineligible under INA 212(a)(4), the examining physician is required to reveal not only the full extent of the condition, but the extent of the approximate treatment needed to care for such condition. Based on the results of the examination, determine whether the disease or disability would be likely to render the applicant unable to care for themself or attend school or work or require extensive medical care or institutionalization. Thus, certain conditions (e.g., developmental disability) are no longer explicitly listed as ineligible conditions. Instead, the examining physician’s diagnosis and opinion regarding treatment and disability would be factors for you to consider in your “totality of the circumstances” analysis of admissibility under INA 212(a)(4). See 9 FAM 302.8-2(B)(3).

c. (U) When the applicant's own resources are not sufficient or are not available for use outside the country of residence and sponsorship affidavits are accepted, the affidavits must include explicit information regarding the arrangements made or the facilities available to the applicant for support in the United States during the proposed period of medical treatment and assurance that a bond will be available if required by DHS.

d. (U) Whenever an NIV applicant is seeking admission for medical treatment, complete information is required regarding the nature of the disease, effect, or disability for which treatment is being sought. If action under INA 212(d)(3)(A) will be required, see 9 FAM 305.4.

9 FAM 302.2-4 Unavailable

9 FAM 302.2-4(A) (U) In General

(CT:VISA-2008; 06-11-2024)

Unavailable

(1) Unavailable

(2) Unavailable

9 FAM 302.2-4(B) Unavailable

(CT:VISA-1979; 04-25-2024)

a. Unavailable

b. Unavailable

c. Unavailable

d. Unavailable

e. Unavailable

9 FAM 302.2-4(C) Unavailable

(CT:VISA-2008; 06-11-2024)

Unavailable

9 FAM 302.2-5 (U) Communicable Diseases - INA 212(a)(1)(A)(i)

9 FAM 302.2-5(A) (U) Grounds

(CT:VISA-1382; 10-01-2021)

(U) INA 212(a)(1)(A)(i) provides that an applicant is ineligible for a visa if the applicant “has a communicable disease of public health significance.”

9 FAM 302.2-5(B) (U) Application

9 FAM 302.2-5(B)(1) (U) Centers of Disease Control and Prevention's Technical Instructions List of Communicable Diseases of Public Health Significance

(CT:VISA-1543; 05-17-2022)

(U) INA 212(a)(1)(A)(i) refers to an ineligible disease as a “communicable disease of public health significance.” The CDC’s Technical Instructions lists these diseases which are also defined at 42 CFR 34.2(b). The following diseases are those that the CDC currently defines as “communicable diseases of public health significance.” As of January 4, 2010, HIV is no longer included on this list.

(1) (U) Communicable diseases listed in a Presidential Executive Order, as provided under Section 316(b) of the Public Health Service Act. The revised list of quarantinable communicable diseases is available at the CDC's website and the Federal Register;

(2) (U) Communicable diseases that may pose a public health emergency of international concern if it meets one or more of the listed factors in 42 CFR 34.3(d);

(3) (U) Gonorrhea;

(4) (U) Hansen’s disease (Leprosy), infectious;

(5) (U) Syphilis, infectious stage; and

(6) (U) Tuberculosis, active.

9 FAM 302.2-5(B)(2) (U) Applicants Infected with Human Immunodeficiency Virus (HIV)

(CT:VISA-1543; 05-17-2022)

a. (U) In General:

(1) (U) HIV-infected applicants who were refused a visa under INA 212(a)(1)(A)(i) before January 4, 2010, are no longer ineligible under INA 212(a)(1)(A)(i). If the applicant requires a medical examination for their visa classification, the applicant must reapply for a visa, complete a new medical examination with a panel physician, and pay all applicable fees. Applicants with known HIV infection who require a medical examination must undergo sputum smears and cultures. NIV applicants are not required to complete a new medical examination to overcome the HIV-infection INA 212(a)(1)(A)(i) ineligibility, unless otherwise required for the visa classification or a separate medical reason.

(2) Unavailable

b. (U) Applicant's Suspected of Being HIV Infected by the Panel Physician: For applicants who may benefit from being tested for HIV, such as those with signs or symptoms suggestive of HIV or those with TB disease, the panel physician may counsel the applicant about HIV, and may administer an HIV serologic test, if the applicant requests and consents to the testing. The applicant may also choose to undergo HIV testing at a non-panel-physician site. The panel physician must also inform the applicant that they do not have to be tested for HIV and that any results of the HIV serologic testing will be provided to the consular section processing their visa application as part of the visa medical examination packet of forms.

9 FAM 302.2-5(B)(3) (U) Immigrant Afflicted with Tuberculosis

(CT:VISA-2008; 06-11-2024)

a. (U) In General: All consular sections are required to use the current version of TB Technical Instructions available on CDC's website.

b. (U) TB TIs:

(1) (U) In General: The medical examination is not complete until you obtain a determination from the panel physician(s) with the application’s tuberculosis classification(s). Applicants should be assigned one or more of the following TB classifications:

(a) (U) No TB classification;

(b) (U) “Class ‘A’ TB” meaning chest x-ray findings suggestive of pulmonary TB and positive sputum smears or positive cultures (see subparagraph (2) below for more information);

(c) (U) "Class B0: TB meaning the applicant was diagnosed with pulmonary TB and successfully completed directly observed therapy and sputum smears and cultures are negative;

(d) (U) “Class ‘B1’ TB, Pulmonary” meaning either;

(i) (U) No treatment – chest x-ray findings are suggestive of pulmonary TB but sputum smear and cultures are negative (see paragraph (d) below for more information); or

(ii) (U) HIV infection, negative sputum smears and culture.

(e) (U) “Class ‘B1’ TB, Extrapulmonary” meaning the applicant has clinically active but not infectious TB, and the chest x-ray or other evidence indicate TB outside of the lung (see paragraph (e) below for more information);

(f) (U) “Class ‘B2’ TB, Latent Tuberculosis Infection (LTBI) Evaluation” meaning the applicant has had a tuberculin skin test (TST) greater than or equal to 10 mm or a positive IGRA but otherwise had a negative evaluation to TB (see paragraph (d) below for more information); or

(g) (U) “Class ‘B3’ TB, Contact Evaluation” meaning the applicant has had contact with a known TB case. Contact is defined as having shared the same enclosed air space (i.e., exposure) in a household or other closed environment for a prolonged period (days or weeks, not minutes or hours) with a person who had a smear and/or culture-positive for pulmonary tuberculosis) (see paragraph (d) below for more information).

(2) (U) Class “A” TB Medical Examinations: For applicants infected with Class “A” TB, the medical examination is not complete until the applicant:

(a) (U) Successfully completes the recommended treatment in accordance with the TB TIs. The Technical Instructions are available on the CDC’s website. The recommended treatment involves directly observed therapy (DOT) where a health care worker watches a patient swallow each dose of medication. DOT treatment enhances adherence and reduces risk of development of drug resistance. The TB TIs require drug susceptibility testing (DST) of sputum cultures to determine which medications will treat the applicant’s disease; and

(b) (U) Has negative sputum smears and culture for acid fast bacilli for three consecutive working days. The TB TIs require laboratory cultures of sputum samples which are more effective in detecting tuberculosis than chest x-rays or sputum smears alone.

(3) (U) Children under 10:

(a) (U) Visa applicants ten (10) years of age or younger who require TB sputum cultures during their visa medical examination, regardless of their HIV infection status, may be medically cleared to travel to the United States immediately after sputum smear analysis (while sputum cultures results are pending) if they do not have:

(i) (U) Sputum smears positive for acid-fast bacilli (AFB);

(ii) (U) Chest x-ray that include one or more cavities and/or extensive disease;

(iii) (U) Respiratory symptoms that include forceful and productive cough; and or

(iv) (U) Are in known contact with a person with multidrug-resistant (MDR) TB who was infectious at the time of contact.

(b) (U) Children who meet the above criteria should be found to have a Class “B1” TB, Pulmonary classification by the examining panel physician. Because this classification is not an ineligibility, you may issue visas to otherwise qualified applicants, without first processing a waiver. If the applicant has other medical ineligibilities, however, then a waiver may still need to be filed. See 9 FAM 302.2-5(D), Waiver, below for more information.

c. (U) “CLASS 'A'" Finding for Infectious Tuberculosis: A visa applicant identified by the panel physician as having Class “A” infectious tuberculosis is ineligible to receive a visa under INA 212(a)(1)(A)(i).

(1) (U) TB TIs: A visa applicant identified by the panel physician as having “Class “A”” infectious tuberculosis is ineligible to receive a visa under INA 212(a)(1). However, in exceptional medical situations, a provision allows applicants undergoing pulmonary tuberculosis treatment to petition for a Class “A” waiver. Waivers can be pursued for any applicant who has a complicated clinical course and who would benefit from receiving treatment of their TB in the United States. Historically these waivers have rarely been granted due to the infectious nature of the illness.

(2) (U) Waivers: You may recommend a waiver of the ground of ineligibility to DHS/USCIS for IV or DHS/CBP for NIV; if the applicant has met certain CDC requirements. See 9 FAM 302.2-5(D)(1) below for waiver procedures for immigrants or 9 FAM 302.2-5(D)(2) for waiver procedures for nonimmigrants.

(3) (U) When Waiver is Not Granted:

(a) (U) Any applicant with Class “A” TB who needs treatment overseas and who is not granted a waiver, is medically ineligible to receive a visa until the completion of successful DOT treatment and follow-up negative sputum smears and cultures at the end of therapy in accordance with the TB TIs. Consistent with other applicants started on tuberculosis treatment before travel, if TB therapy is started for an applicant ten years of age or younger, the applicant should be found to have a Class “A” TB classification by the panel physician. In this case, a Class “A” waiver can be filed with CDC so that it can be reviewed and the applicant can travel to the United States before completion of therapy.

(b) (U) For any Class “A” TB case involving a young child, the CDC supports the filing of a waiver application so that they may review and adjudicate it promptly.

(4) (U) Refusal of Treatment: Do not issue a visa to applicants with positive sputum smears or positive cultures who do not want to be treated.

(5) (U) History of Noncompliance: Do not issue a visa to an applicant with a history of noncompliance until they have completed DOT treatment in accordance with the TB TIs.

d. (U) Class “B” Finding for Infectious Tuberculosis: An applicant who is found to have Class “B” medical condition for tuberculosis is not ineligible under INA 212(a)(1)(A)(i).

e. (U) Medical Treatment at U.S. Military Institution: Although applicants who are dependents of U.S. military personnel may not use U.S. military facilities for visa-related medical examinations, such facilities are authorized to treat dependents that have tuberculosis. Those military facilities designated by the Surgeon General of any of the U.S. Armed Services, or by the Chief Surgeon of any major Army command abroad, are acceptable to the CDC for the treatment of tuberculosis. A statement from the Surgeon General or a Chief Surgeon that the applicant will be admitted for treatment may be accepted as meeting the requirements of 9 FAM 302.2-5(D)(2). The name and address of the military hospital in the United States where the treatment will be provided must be shown on Form I-601, Application for Waiver of Ground of Inadmissibility, Section B.

9 FAM 302.2-5(C) (U) Advisory Opinion

(CT:VISA-1247; 03-10-2021)

(U) An AO is not required for a potential INA 212(a)(1)(A)(i) ineligibility; however, if you have a question about the interpretation or application of law or regulation, you may request an AO from L/CA. If you have question about the application of policy or procedure contact CA/VO/F.

9 FAM 302.2-5(D) (U) Waiver

9 FAM 302.2-5(D)(1) (U) Waivers for Immigrants

(CT:VISA-2008; 06-11-2024)

a. (U) In General: INA 212(g) provides for a discretionary waiver of subsections (i) of INA 212(a)(1)(A) if the applicant is:

(1) (U) The spouse, unmarried son or daughter, or the minor unmarried lawfully adopted child of:

(a) (U) A U.S. citizen;

(b) (U) An LPR; or

(2) (U) The parent of:

(a) (U) A U.S. citizen son or daughter;

(b) (U) An LPR; or

(3) (U) A VAWA self-petitioner (as defined in INA 101(a)(51)).

b. (U) Waivers for "Class A" Tuberculosis:

(1) (U) Waivers for IV applicants identified by the panel physician as being afflicted with Class “A” infectious tuberculosis are only for exceptional medical situations because of the infectious nature of the illness. If the applicant requires a completed clinical treatment course that they can only receive in the United States, the applicant should provide that information to USCIS.

(2) (U) You may inform an applicant that they may file a Form I-601 with USCIS for a waiver of medical grounds of ineligibility if the applicant qualifies per above. For cases involving communicable diseases, the applicant must be the spouse, unmarried son or daughter (regardless of age), or parent of a U.S. citizen, of an LPR, or of an applicant who has been issued an IV or must be a VAWA self-petitioner (as defined in INA 101(a)(51)).

(3) (U) If you determine that the IV applicant is eligible to apply for the waiver, direct the applicant to the Form I-601 instructions on the USCIS website.

(4) (U) For complete NIV medical waiver procedures, see 9 FAM 302.2-5(D)(2) below.

c. (U) Procedures:

(1) (U) If you determine that an IV applicant is eligible to apply for a waiver of their ineligibilities, you should instruct the applicant to file Form I-601, Application for Waiver of Ground of Inadmissibility, with USCIS per the instructions for Form I-601.

(2) (U) When you refuse an IV case on medical grounds of ineligibility, visa staff must scan the medical exam file into CCD so that it can be accessed by I-601 adjudicators at the USCIS Nebraska Service Center (NSC).

(3) (U) When the NSC receives an I-601 seeking to waive a ground of ineligible under INA 212(a)(1)(A)(i) or (iii), the NSC will download a copy of the medical exam and any related medical records from CCD and send a copy of the Form I-601, medical exam and related medical records to the CDC for review. The NSC will not approve the Form I-601 until after consulting with CDC.

(4) (U) If USCIS approves the waiver, and the applicant has no other ineligibilities, you may issue the visa.

9 FAM 302.2-5(D)(2) (U) Waivers for Nonimmigrants

(CT:VISA-1543; 05-17-2022)

a. (U) In General: If you determine that an applicant is ineligible for an NIV under INA 212(a)(1)(A), you may recommend to CBP, through the Admissibility Review Information Service (ARIS) system, that a waiver under INA 212(d)(3)(A) be granted to the applicant. CBP may, in its discretion, authorize a waiver to allow the applicant's temporary admission. See 9 FAM 305.4-3(E)(1).

b. (U) Waivers for NIV Applicants Afflicted with "Class A" Tuberculosis: Do not recommend a waiver for an NIV applicant identified by the panel physician as being afflicted with Class “A” infectious tuberculosis unless they have a complicated clinical course and would benefit from receiving TB treatment in the United States. This type of waiver is for exceptional medical situations and historically these waivers have rarely been granted, due to the infectious nature of the illness.

c. (U) Applicants Traveling for Medical Reasons: The requirements listed below must be fulfilled in the case of an applicant intending to travel for medical treatment of a condition that leads to a finding of ineligibility under INA 212(a)(1)(A)(i). When a waiver of a medical ground of ineligibility is deemed necessary, the applicant must establish that arrangements, including financial, have been made for treatment. When the personal resources of an applicant are not sufficient or may not be available outside the applicant's country of residence, the applicant must include explicit information regarding which facilities are available for support during the proposed medical treatment. The sponsor of the affidavit must confirm that a bond will be made available if required by the DHS.

9 FAM 302.2-5(D)(3) (U) Additional Waiver Information

(CT:VISA-2008; 06-11-2024)

a. (U) Applicant Ineligible Under Grounds Other than INA 212(a)(1): Although any applicant who has a medical ineligibility and qualifying relationship may apply for a waiver, you should not advise an applicant to file an I-601 waiver if an applicant has other grounds of ineligibility that cannot be waived. If the applicant is ineligible under a ground of the INA that cannot be waived, you may not issue a visa even if the INA 212(a)(1) ineligibility could be or is waived. An applicant ineligible under multiple grounds may apply for a waiver of other ineligibility grounds at the same time as the waiver for INA 212(a)(1) ineligibility on the same Form I-601.

b. (U) Simultaneous Visa Issuance to Family Members: To prevent separation of families, when an accompanying family member must seek a waiver, the principal applicant should be encouraged to begin the waiver procedures promptly.

c. (U) Issuing New or Replacement Visas: You may issue a new or replacement visa to an applicant who was previously granted a waiver under INA 212(g) if the conditions for the waiver are still met.

d. (U) Validity of Waiver for Subsequent Entries: The Department has accepted a DHS ruling that a waiver granted under INA 212(g) remains in full force and effect for any subsequent entries by the individual if:

(1) (U) The waiver remains unrevoked;

(2) (U) No new grounds of ineligibility have arisen; and

(3) (U) The individual is complying with the conditions imposed in the original waiver.

9 FAM 302.2-5(E) Unavailable

9 FAM 302.2-5(E)(1) Unavailable

(CT:VISA-2008; 06-11-2024)

Unavailable

9 FAM 302.2-5(E)(2) Unavailable

(CT:VISA-1369; 09-16-2021)

Unavailable

9 FAM 302.2-6 (U) Required vaccinations - INA 212(a)(1)(A)(ii)

9 FAM 302.2-6(A) (U) Grounds

(CT:VISA-1543; 05-17-2022)

(U) INA 212(a)(1)(A)(ii) provides that an individual is ineligible for an IV if the individual lacks the required vaccinations. Internationally adopted children (IR-3s, IR-4s, IH-3s, and IH-4s) 10 years of age or younger are exempt from vaccination requirement before visa issuance but the adoptive parents must sign the DS-1981 affidavit stating they will vaccinate their children within 30 days of arrival in the United States.

9 FAM 302.2-6(B) (U) Application

9 FAM 302.2-6(B)(1) (U) Required Vaccinations

(CT:VISA-1979; 04-25-2024)

a. (U) Specified and Recommended Vaccinations: Although INA 212(a)(1)(A)(ii) lists specific vaccine-preventable diseases, the language of INA 212(a)(1)(A)(ii) requires immigrants “to present documentation of having received vaccination against vaccine-preventable diseases” including any other vaccinations against vaccine preventable diseases recommended by the Advisory Committee for Immunization Practices (ACIP).

b. (U) ACIP Recommendations: On November 13, 2009, the CDC issued a final notice, which changed the criteria for requiring vaccinations based on recommendations from the ACIP. Effective December 14, 2009, for a vaccination recommended by ACIP to be required for immigrants under the new criteria, the vaccine must:

(1) (U) Be age appropriate as recommended by ACIP for the general U.S. population; and

(2) (U) Protect against a disease that has the potential to cause an outbreak; or

(3) (U) Protect against a disease that has been eliminated in the United States or is in the process of being eliminated.

c. (U) Currently Required Vaccinations: Vaccinations currently required by CDC are as follows (Many vaccines have age-appropriate guidelines):

(1) (U) Mumps;

(2) (U) Measles;

(3) (U) Rubella;

(4) (U) Polio;

(5) (U) Tetanus;

(6) (U) Diphtheria;

(7) (U) Pertussis;

(8) (U) Haemophilus influenzae Type B

(9) (U) Rotavirus;

(10) (U) Hepatitis A;

(11) (U) Hepatitis B;

(12) (U) Meningococcal disease;

(13) (U) Varicella;

(14) (U) Pneumococcal;

(15) (U) Influenza;

(16) (U) COVID-19.

d. (U) Dosage: Applicants are required to receive at least one dose of each age-appropriate vaccine. If the applicant had previously received a dose or doses of a required vaccine but had not completed the series, then the next required dose should be administered. Although applicants are not required to complete routine vaccine series they are encouraged to receive as many as possible before travel to the United States. The vaccinations required by the CDC include:

(1) (U) Vaccinations against vaccine-preventable diseases explicitly listed in INA 212(a)(1)(A)(ii); and

(2) (U) Vaccinations recommended by the ACIP for U.S. immigration purposes.

e. (U) ACIP Contact: For information regarding the ACIP, contact:

Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention

1600 Clifton Road, N.E., Mailstop E-05

Atlanta, GA 30333 USA

Phone: 404-639-8836

Fax: 404-639-8905

Email: acip@cdc.gov

9 FAM 302.2-6(B)(2) (U) “Not Medically Appropriate”

(CT:VISA-2008; 06-11-2024)

(U) The CDC and the Department accept that in many cases it might not be medically appropriate to administer a dose of a specific vaccine. Form DS-3025 has six “Not Medically Appropriate” categories that are acceptable. These categories should be used when determining an applicant’s eligibility for a blanket waiver. A blanket waiver is a waiver that is applied uniformly to a group of conditions and does not require a separate waiver application or fee to be filed with USCIS. The six categories are:

(1) (U) Not age appropriate – this box will need to be checked for at least one of the required vaccines for all applicants. For example, infants and adults do not need all the same vaccinations.

(2) (U) Insufficient time interval between doses – this box will be checked if administration of the single dose of a vaccine at the time of the medical examination does not complete the series for that vaccine. Only one dose of each series is required to be administered by the panel physician for immigration purposes.

(3) (U) Contraindicated – A contraindication is a condition in a recipient which is likely to result in a life-threatening problem if the vaccine is given (i.e., an allergic reaction).

(4) (U) Not routinely available – “Not routinely available” can mean that a vaccine is not available in a particular country, that a panel site does not regularly stock the vaccine, or that due to a shortage it cannot be obtained in a reasonable amount of time. Cost should not be a factor of consideration. For the COVID-19 vaccination, if a law or regulation in the country where the exam is performed prevents the applicant from receiving a dose at the time of the exam, the panel physician should document the “Not routinely available” blanket waiver.

(5) (U) Not fall (flu) season – The influenza vaccine is required during the influenza (flu) season; if it is not flu season when the visa is processed, this vaccination is not required. Influenza occurs throughout the year in tropical areas.

(6) (U) Known chronic Hepatitis B virus infection - Individuals with Hepatitis B are not required to receive the Hepatitis B vaccine.

9 FAM 302.2-6(B)(3) (U) Vaccination Requirements for K-Visa Applicants

(CT:VISA-1543; 05-17-2022)

(U) In General: K-visa applicants, as NIV applicants, technically are not subject to INA 212(a)(1)(A)(ii) vaccination requirements. However, we and DHS have agreed that medical exams for K-visa applicants should include the vaccination assessment as a matter of expediency. Every effort should be made, therefore, to encourage K- visa applicants to meet the routine vaccination requirements before admission to the United States. Nevertheless, do not refuse a K-visa applicant for refusing to meet the vaccination requirement.

9 FAM 302.2-6(B)(4) (U) Vaccination Requirements for Foreign Adopted Children

(CT:VISA-1543; 05-17-2022)

a. (U) Exemption: Applicants for IH-3, IR-3, IH-4, and IR-4 IVs who are age 10 year or younger are exempt from the vaccination requirement if:

(1) (U) before the child’s admission to the United States, an adoptive parent or prospective adoptive parents executes Form DS-1981, Affidavit Concerning Exemption from Immigrant Vaccination Requirements for a Foreign Adopted Child, stating that they are aware of the vaccination requirement;

(2) (U) the adoptive or prospective adoptive parent(s) will ensure that, within 30 days of the child’s admission to the United States, or at the earliest time that is medically appropriate, the child will comply with the INA 212(a)(1)(A)(ii) vaccination requirement; and

(3) (U) the adoptive or prospective adoptive parent(s) provide an original copy of the signed affidavit to you either before or at the time of the visa interview for inclusion in the case file. (This copy must be attached to Form DS-2054 and included with the supporting documents attached to the issued IH-3, IR-3, IH-4, or IR-4 visa.)

b. (U) Panel Physician's Role and Form DS-1981:

(1) (U) A panel physician may accept the verbal assurances of an adoptive parent, prospective adoptive parent, or individual representing the child’s interests, as evidence that a completed Form DS-1981, Affidavit Concerning Exemption From Immigrant Vaccination Requirements for a Foreign Adopted Child, will be presented on behalf of the child at the time of the visa interview. In such cases, the panel physician should not conduct a vaccination assessment as part of the medical interview.

(2) (U) The adoptive or prospective adoptive parent must provide a copy of the signed Form DS-1981 to you either before or at the time of the visa interview. The copy is to be included in the case file. This copy must be attached to the Form DS-3025 and included with the supporting documents attached to the issued IH-3, IR-3, IH-4, or IR-4 visa.

9 FAM 302.2-6(B)(5) (U) Fraudulent Vaccination Records

(CT:VISA-1543; 05-17-2022)

a. (U) Acceptable Documentation: Acceptable vaccination documentation must come from a vaccination record, either a personal vaccination record or a copy of the medical chart record with entries made by the physician or other appropriate medical personnel. Only those records of doses or vaccines that include the dates of receipt (month, day, and year) are acceptable. Self-reported doses of vaccines without written documentation are not acceptable. This could mean that the applicant might be required to repeat doses of vaccines that they have received if they are not able to provide sufficient acceptable documentation. In accordance with the CDC Technical Instructions, administering a second dose, however, will not endanger the applicant’s health.

b. (U) Suspected Fraudulent Documentation: If the panel physician believes that the applicant’s vaccination record is fraudulent, you should treat the applicant in the same fashion as if they failed to present the vaccination record. You should mention any incidents of potential vaccination fraud in the Notes section of the CCD case file.

c. (U) Designated Vaccination Facilities: To guarantee that applicants receive the required vaccinations and to guard against fraudulent vaccination records, the CDC has agreed that consular sections may require applicants to receive the vaccinations from designated facilities. These facilities must follow the Technical Instructions on Vaccinations Requirements. Consular sections that plan to designate a specific facility must provide CA/VO/F and the CDC with the name and address of the facility. The panel physician must still review the applicant’s vaccination record, Form DS-3025.

9 FAM 302.2-6(B)(6) (U) Cost of Vaccinations

(CT:VISA-2008; 06-11-2024)

(U) The CDC and the Department accept that some panel physicians will raise the cost of the medical examination to account for the cost of vaccinations. The costs for the vaccinations and the administering of such vaccination, however, should not be more than those charged the public.

9 FAM 302.2-6(C) (U) Advisory Opinion

(CT:VISA-1399; 10-22-2021)

a. (U) An AO is not required for a potential INA 212(a)(1)(A)(ii) ineligibility; however, if you have a question about the interpretation or application of law or regulation, you may request an AO from L/CA.

b. (U) If you have question about the application of policy or procedure contact CA/VO/F.

9 FAM 302.2-6(D) (U) Waiver

9 FAM 302.2-6(D)(1) (U) Waivers for Immigrant Visa Applicants

(CT:VISA-2008; 06-11-2024)

a. (U) In General:

(1) (U) Grounds for Waiver: An IV applicant who is ineligible under INA 212(a)(1)(A)(ii) may benefit from an INA 212(g)(2)(A) or INA 212(g)(2)(B) waiver if:

(a) (U) The missing vaccinations are received later; or

(b) (U) The panel physician determines that administration of the required vaccination would be medically inappropriate given the applicant’s age, medical history, or current medical condition.

(2) (U) Blanket Authority: DHS/USCIS has delegated blanket authority to you to grant INA 212(g)(2)(A) and INA 212(g)(2)(B) waivers without the need for a fee or the filing of a form.

(3) (U) Religious or Moral Objections: IV applicants who object to receiving vaccinations on religious or moral grounds must seek an INA 212(g)(2)(C) waiver from DHS/USCIS by filing Form I-601, Application for Waiver of Grounds of Inadmissibility. You do not have the authority to adjudicate or grant INA 212(g)(2)(C) waivers.

b. (U) Waiver Under INA 212(g)(2)(A): INA 212(g)(2)(A) appears to have been written chiefly to accommodate cases where an applicant seeks adjustment of status. Since medical exams for most immigrant applicants are conducted before the visa interview, most applicants will not need an INA 212(g)(2)(A) waiver. However, in cases where the applicant appears for the interview without a completed Form DS-2054 (i.e., before their medical examination), refuse the application under INA 212(a)(1)(A)(ii) and tell the applicant to return to the panel physician to complete the medical examination. Once the medical examination, including the required vaccinations, is complete, the applicant will obtain the completed Form DS-2054 from the panel physician. The form is submitted to you, and you should approve the blanket waiver under INA 212(g)(2)(A).

c. (U) Waiver Under INA 212(g)(2)(B): INA 212(g)(2)(B) provides a waiver in cases where the panel physician determines that a required vaccination is medically inappropriate. In such cases, the panel physician will indicate on page two of Form DS-2054 if the vaccine history is incomplete and which type of waiver is requested. Refer to Form DS-3025 and may then authorize a waiver in accordance with INA 212(g)(2)(B) for any of the following reasons:

(1) (U) Not age appropriate;

(2) (U) Contraindication;

(3) (U) Insufficient time interval to complete series;

(4) (U) Flu vaccine not available; or

(5) (U) Not routinely available;

(6) (U) Known chronic Hepatitis B virus infection.

d. (U) Waiver Under INA 212(g)(2)(C):

(1) (U) Basis for Waiver: The Secretary of Homeland Security may authorize an INA 212(g)(2)(C) waiver when the applicant establishes that compliance with the vaccination requirements for immigrants would be contrary to their religious beliefs or moral convictions.

(2) (U) You may inform an applicant seeking a waiver under INA 212(g)(2)(C) that they may file a Form I-601 with USCIS for a waiver of medical grounds of ineligibility if the applicant qualified per 9 FAM 302.2-6(C).

(3) (U) Procedures: If you determine that the IV applicant is eligible to apply for the waiver, direct the applicant to the Form I-601 instructions on USCIS's website.

(4) (U) Waivers for IR-3 or IR-4 Applicants: Applicants for IH-3, IR-3, IH-4, or IR-4 IVs who are 10 years of age or younger are exempt from the vaccination requirement if:

(a) (U) Adoptive or prospective adoptive parent(s) could otherwise take advantage of the exemption from the vaccination requirement available to IH-3, IR-3, IH-4, and IR-4 applicants; and

(b) (U) Adoptive or prospective adoptive parent(s) must seek an INA 212(g)(2)(C) waiver on behalf of their adopted child. This is because the exemption available to IH-3, IR-3, IH-4, and IR-4 applications is conditioned on the adoptive parent signing Form DS-1981, attesting that the child will receive any required and medically appropriate vaccinations following their arrival in the United States.

9 FAM 302.2-6(D)(2) (U) Additional Waiver Information

(CT:VISA-2008; 06-11-2024)

a. (U) Applicant Ineligible Under the Grounds: Although any applicant who has a medical ineligibility and qualifying relationship may apply for a waiver, you should not advise an applicant to file an I-601 waiver if an applicant has other grounds of ineligibility that cannot be waived. If the applicant is ineligible under a ground of the INA that cannot be waived, you may not issue a visa even if the INA 212(a)(1) ineligibility could be or is waived. An applicant ineligible under multiple grounds may apply for a waiver of other ineligibility grounds at the same time as the waiver for INA 212(a)(1) ineligibility on the same Form I-601.

b. (U) Simultaneous Visa Issuance to Family Members: To prevent separation of families, when an accompanying family member must seek a waiver under INA 212(g), the principal applicant should be encouraged to begin the waiver procedures promptly.

c. (U) Issuing New or Replacement Visas: You may issue a new or replacement visa to an applicant who was previously granted a waiver under INA 212(g) if the conditions for the waiver are still met.

d. (U) Validity of Waiver for Subsequent Entries: The department has accepted a DHS ruling that a waiver granted under INA 212(g) remains in full force and effect for any subsequent entries by the applicant if:

(1) (U) The waiver remains unrevoked;

(2) (U) No new grounds of ineligibility have arisen; and

(3) (U) The applicant is complying with the conditions imposed in the original waiver.

9 FAM 302.2-6(E) Unavailable

9 FAM 302.2-6(E)(1) Unavailable

(CT:VISA-2008; 06-11-2024)

Unavailable

9 FAM 302.2-6(E)(2) Unavailable

(CT:VISA-1399; 10-22-2021)

Unavailable

9 FAM 302.2-7 (U) Physical or Mental Disorders with associated harmful behavior including substance-related disorder - ina 212(a)(1)(a)(iii)

9 FAM 302.2-7(A) (U) Grounds

(CT:VISA-1537; 04-28-2022)

(U) INA 212(a)(1)(A)(iii) provides that an individual is ineligible for a visa if the individual has a physical or mental disorder and behavior associated with that disorder that may pose, or has posed, a threat to the property, safety, or welfare of the individual or others.

9 FAM 302.2-7(B) (U) Application

9 FAM 302.2-7(B)(1) (U) Basis for Finding an Individual Ineligible

(CT:VISA-1273; 05-04-2021)

(U) The mere presence of a physical and mental disorder does not by itself render the applicant ineligible. Under INA 212(a)(1)(A)(iii)(I) and INA 212(a)(1)(A)(iii)(II) to find the applicant ineligible, it must be determined that the applicant:

(1) (U) Has a current 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 applicant or others; or

(2) (U) Has had a physical or mental disorder and a history with behavior associated with the disorder, which behavior has posed a threat to the property, safety, or welfare of the applicant or others and which behavior is likely to recur or lead to other harmful behavior in the future.

9 FAM 302.2-7(B)(2) (U) Key Concepts of Mental Health

(CT:VISA-1382; 10-01-2021)

a. (U) Physical and Mental Health Disorder Key Concepts: Only medical conditions that are included in the current version of the World Health Organization’s Manual of International Classification of Diseases (ICD) are considered for visa medical exams.

(1) (U) A physical disorder is a clinically diagnosed medical condition where the focus of attention is physical manifestations.

(2) (U) Mental disorders are health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof).

(3) (U) Harmful behavior is defined as an action associated with a physical or mental disorder that is or has caused:

(a) (U) Serious psychological or physical injury to the applicant or to others (e.g., suicide attempt or pedophilia);

(b) (U) A serious threat to the health or safety of the applicant or others (e.g., driving while intoxicated or verbally threatening to kill someone); and

(4) (U) Current harmful behavior is defined as currently engaging in harmful behavior that has continuously occurred and seems ongoing.

(5) (U) A determination of future harmful behavior must be made if the applicant presently is or has in the past engaged in harmful behavior associated with a physical or mental disorder, and the panel physician must evaluate whether the harmful behavior is likely to recur. Many factors impact this determination of classification, and the decision requires clinical judgment.

(6) (U) Only harmful behavior that is associated with a physical or mental disorder is relevant for the classification of visa ineligibility. Neither harmful behavior nor the physical or mental disorder alone causes an applicant to be medically ineligible.

b. (U) Remission:

(1) (U) The current version of the DSM defines sustained, full remission as a period of at least 12 months during which no associated substance abuse or mental disorder or associated harmful behavior has occurred. The panel physician has discretion to use their clinical judgment to determine if 12 months is an acceptable period for an individual applicant to demonstrate sustained, full remission.

(2) (U) For general mental disorders, the determination of remission must be made based on the assessment of associated harmful behavior, either current or a history of harmful behavior judged likely to recur, and DSM criteria. This includes substance-related disorders for those substances, including alcohol, not listed in Schedules I through V of Section 202 of the Controlled Substances Act.

9 FAM 302.2-7(B)(3) (U) Substance-Related Disorders Under INA 212(a)(1)(A)(iii) - Alcohol and Other Non-Controlled Substances

(CT:VISA-2008; 06-11-2024)

a. (U) In General: Although INA 212(a)(1)(A)(iii) does not refer explicitly to alcoholics or alcoholism, substance-related disorders including alcohol use disorder constitute a medical condition. The same criteria apply for evaluation of dependence or abuse of alcohol as are found in the current DSM for other substances (drugs). The diagnosis of a substance-related disorder alone does not make an applicant ineligible to receive a visa unless there is evidence of current or past harmful behavior associated with the disorder that has posed or is likely to pose a threat to the property, safety, or welfare of the applicant or others in the future.

(1) (U) To establish any substance-related disorder diagnosis, the examining physician must document the pattern or use of the substance and behavioral, physical, and psychological effects associated with the use or cessation of use of that substance. Diagnoses of substance-related disorders are to be made in accordance with existing medical standards as determined by the current edition of the DSM. In the current DSM, substance-related disorders are divided into the following two groups: substance-use disorders and substance-induced disorders.

(2) (U) Substance-use disorders: The essential feature of a substance use disorder is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems. The DSM criteria for substance use disorders fit within overall groupings of impaired control, social impairment, risky use, and pharmacological criteria. Pharmacological criteria include tolerance and withdrawal.

(3) (U) Substance-induced disorders: In addition to substance-use disorders, the DSM has a separate category called substance-induced disorders. The DSM list of substance-induced disorders includes but is not limited to intoxication, withdrawal, and other substance/medication-induced disorders (psychotic disorders, bipolar and related disorders, depressive disorders, anxiety disorders, obsessive-compulsive and related disorders, sleep disorders, sexual dysfunctions, delirium, and neurocognitive disorders/substance-induced psychotic disorder, and substance-induced depressive disorder.

b. (U) Referring Applicants to the Panel Physician: To ensure proper evaluation, refer applicants (immigrant and nonimmigrant) to the panel physician when they have:

(1) (U) A single alcohol related arrest or conviction within the last five years;

(2) (U) Two or more alcohol related arrests or convictions with the last ten years; or

(3) (U) If there is any other evidence to suggest an alcohol problem.

c. (U) Medical Examination Required: Applicants, including NIV applicants, who are referred to a panel physician due to alcohol-related offenses must receive a full medical exam evaluation, less the vaccination requirements for NIV applicants. Chest X-rays and any other necessary testing must be conducted for the exam to be considered complete.

d. (U) Repeat Medical Examination: An NIV applicant with a single alcohol-related arrest or conviction within the last five years, who the panel physician finds to have a Class “B” or no physical or mental condition, who is otherwise eligible to receive a visa, and who has not had another alcohol-related arrest or conviction since the original or previous exam does not have to repeat the medical exam with each new NIV application. If an applicant diagnosed with a substance-related disorder and classified with a Class “A” condition for any physical or mental (including other substance-related disorder with harmful behavior or history of such behavior likely to recur under INA 212(a)(1)(A)(iii)) or has two or more alcohol-related arrests or convictions within the last ten years, the applicant must be referred to the panel physician with each new NIV application if the original medical exam has expired.

e. (U) You may discover during an adjudication that an applicant was previously arrested/convicted for an alcohol or substance-related offense. If the applicant failed to disclose this information during the initial examination to the panel physician, then you may choose to refer the applicant to the panel physician for a second evaluation and provide information regarding the relevant previous incident/s to the panel physician. The panel physician is authorized to charge the applicant again for just the mental health evaluation.

9 FAM 302.2-7(B)(4) (U) Screening

(CT:VISA-177; 09-15-2016)

(U) The medical screening for physical and mental disorders with associated harmful behavior is required by law and is an essential component of the medical examination of visa applicants.

9 FAM 302.2-7(B)(5) (U) Role of the Panel Physician in Evaluating Physical or Mental Disorders with Associated Harmful Behavior

(CT:VISA-1979; 04-25-2024)

a. (U) Technical Instructions: Effective June 1, 2021, the CDC updated the Technical Instructions for Physical or Mental Disorders with Associated Harmful Behavior and Substance Related Disorders (MH TIs) to provide clarification that the diagnosis of physical and mental disorders with associated harmful behavior and substance-related disorders is made based on existing medical standards, as determined by the current version of the DSM. Panel physicians must follow these new instructions when evaluating visa applicants for physical or mental disorders with associated harmful behavior and substance-related disorders.

b. (U) Medical Examination: As part of the medical examination of applicants, the panel physician will carry out or obtain a mental health evaluation:

(1) (U) To identify and diagnosis any physical or mental disorder (including substance-related disorders);

(2) (U) To identify any harmful behavior associated with a disorder;

(3) (U) To identify the use of drugs, other than those required for medical reasons, and diagnosis any substance-related disorder;

(4) (U) To determine the remission status of any disorder previous diagnosis; and

(5) (U) To determine the likelihood of recurrence of harmful behaviors associated with a physical or mental disorder.

c. (U) Disorder Can Be Noted at Any Time During the Examination: The panel physician can recognize that an applicant with a physical or mental disorder must have associated harmful behavior during any point of the examination (while taking the medical history or a mental disorder, while taking history of harmful behavior, or while observing for current abnormal behavior during the physical examination.

d. (U) Multiple Appointments: For most applicants, the panel physician’s examination will require only one appointment. However, for some applicants multiple appointments or specialist consultations may be required to make an accurate diagnosis of whether the applicant has a Class “A” or Class “B” condition as it is related to physical or mental disorders with associated harmful behavior.

9 FAM 302.2-7(B)(6) (U) Referrals to Mental Health Specialists for Further Evaluation

(CT:VISA-1979; 04-25-2024)

a. (U) Required Referrals: The panel physician may refer an applicant to a specialist consultant (that is agreed upon with a consular section) if after the medical interview, review of records (including Form DS-3026) and performing a mental status and physical examination, the panel physician is not able to:

(1) (U) Arrive at a probable psychiatric diagnosis for purposes of determinate of a mental disorder with associated harmful behavior (past or present); or

(2) (U) Arrive at a probable diagnosis of a substance-related disorder according to DSM criteria; or

(3) (U) Classify as a Class “A” or “B” condition.

(4) (U) Cases to be Referred Locally if Possible: Since CDC does not currently have physicians stationed abroad to whom panel physicians may refer doubtful cases, you should inform local panel physicians that whenever further medical consultation is deemed advisable, the applicant should be referred to an appropriate local specialist at the applicant’s expense. Under generally accepted medical procedures, the specialist should report the findings and opinion to the panel physician who remains responsible for the completion of medical screening forms (see 9 FAM 302.2-3(F)(2) above) and results of the medical examination.

b. (U) Referral to CDC: If an applicant is referred to a specialist for psychiatric evaluation and further assistance in determining the diagnosis and classification is needed CDC’s Division of Global Migration Health (DGMH) may be consulted. If CDC/DGMH is consulted, a copy of all pertinent medical information may be faxed to (404) 639-4441 or sent via secure email to cdcqap@cdc.gov.

9 FAM 302.2-7(B)(7) (U) Determine Class “A” or Class “B” Physical or Mental Disorders with Associated Harmful Behaviors

(CT:VISA-1382; 10-01-2021)

(1) (U) A current physical or mental disorder with associated harmful behavior; and/or

(2) (U) A history of mental disorder with associated harmful behavior if the harmful behavior is likely to recur or to lead to other harmful behavior in the future.

b. (U) Class B Condition: Class “B” medical conditions are not medically ineligible conditions and includes applicants who are determined to have a physical or mental abnormality, disease, or disability serious in degree or nature amounting to a substantial departure from well-being.

c. (U) Deferring Classification: If a panel physician is unable to determine whether an applicant has a diagnosis of a physician or mental disorder, or substance-related disorder, then classification may be deferred to obtain additional medical evidence. When this occurs, the panel physician must explain to the applicant that they would like to see the applicant during the next 3 to 6 months to determine if abstinence is present (to classify the applicant).

d. (U) Multiple Classifications: Applicants may have more than one classification. However, applicant cannot be classified as both Class “A” and “B” for the same physical or mental disorder.

e. (U) Classifications and Descriptions: Physical and mental disorders with associated harmful behavior and substance-related disorders classification and description are listed below:

(1) (U) No Class “A” or Class “B” Classification - The applicant has no diagnosis of a physical or mental disorder, or substance related disorder.

(2) (U) Class “A” Physical or Mental Disorder with Associated Harmful Behavior or History of Such Behavior Likely to Recur (includes alcohol and other substances NOT listed in Schedule I-V of Section 202 of the Controlled Substances Act);

(3) (U) Class “B” Current Physical or Mental Disorder with No Associated Harmful Behavior (includes alcohol and other substances NOT listed in Schedule I-V of Section 202 of the Controlled Substances Act); and

(4) (U) Class “B” History of Physical or Mental Disorder with Associated Harmful Behavior Unlikely to Recur (includes alcohol and other substances NOT listed in Schedule I-V of Section 202 of the Controlled Substances Act).

9 FAM 302.2-7(B)(8) (U) Applicants with Previous INA 212(a)(1)(A)(iii) Ineligibilities

(CT:VISA-1543; 05-17-2022)

(U) For cases previously refused under INA 212(a)(1)(A)(iii) due to a Class “A” medical finding you should take the following steps:

(1) Unavailable

(2) Unavailable

9 FAM 302.2-7(C) (U) Advisory Opinion

(CT:VISA-1247; 03-10-2021)

(U) An AO is not required for a potential INA 212(a)(1)(A)(iii) ineligibility; however, if you have a question about the interpretation or application of law or regulation, you may request an AO from L/CA. If you have question about the application of policy or procedure contact CA/VO/F.

9 FAM 302.2-7(D) (U) Waiver

9 FAM 302.2-7(D)(1) (U) Waivers for Immigrants

(CT:VISA-1543; 05-17-2022)

(U) The Secretary of Homeland Security may, under terms that they set forth, in their discretion, and after consultation with the Secretary of Health and Human Services, grant a waiver to an applicant ineligible under INA 212(a)(1)(A)(iii).

9 FAM 302.2-7(D)(2) (U) Waivers for Nonimmigrants

(CT:VISA-1273; 05-04-2021)

a. (U) In General: If you determine that an applicant is ineligible for an NIV under INA 212(a)(1)(A)(iii), you may recommend to DHS/CBP, through ARIS, that a waiver under INA 212(d)(3)(A) be granted to the applicant. DHS/CBP may, in its discretion, authorize a waiver to allow the applicant temporary admission. See 9 FAM 305.4-3(E)(1).

b. (U) Travel for Medical Reasons: The requirements listed below must be fulfilled in the case of an applicant traveling for medical treatment of a condition that leads to a finding of ineligibility under INA 212(a)(1)(A)(iii). When a waiver of a medical ground of ineligibility is deemed necessary, the applicant must establish that arrangements, including financial, have been made for treatment. When the personal resources of an applicant are not sufficient or may not be available outside the applicant's country of residence, the applicant must include explicit information regarding which facilities are available for support during the proposed medical treatment. The sponsor of the affidavit must confirm that a bond will be made available if required by the DHS.

9 FAM 302.2-7(E) Unavailable

9 FAM 302.2-7(E)(1) Unavailable

(CT:VISA-2008; 06-11-2024)

Unavailable

9 FAM 302.2-7(E)(2) Unavailable

(CT:VISA-177; 09-15-2016)

Unavailable

9 FAM 302.2-8 (U) Drug Abuse or Addiction - ina 212(a)(1)(A)(iv)

9 FAM 302.2-8(A) (U) Grounds

(CT:VISA-177; 09-15-2016)

(U) INA 212(a)(1)(A)(iv) provides that an individual is ineligible for a visa if the individual is a drug abuser or drug addict.

9 FAM 302.2-8(B) (U) Application of Grounds

9 FAM 302.2-8(B)(1) (U) Basis for Finding an Individual Ineligible

(CT:VISA-177; 09-15-2016)

a. (U) In General: For a Class “A” determination under INA 212(a)(1)(A)(iv) for drug abuse or drug addiction, an applicant must meet current DSM diagnostic criteria for substance-related disorder with any the specific substances listed in Schedule I through V of Section 202 of the Controlled Substances Act. Such a Class “A” medical determination by the panel physician, renders the applicant ineligible for a visa under INA 212(a)(1)(A)(iv).

b. (U) No Harmful Behavior Required: Harmful behavior is not a relevant factor in rendering a determination of ineligibility under the provisions of INA 212(a)(1)(A)(iv).

c. (U) Non-Section 202 Substance Dependence: An applicant that meets current DSM criteria for a substance-related disorder for other substances, including alcohol, not listed in Schedules I through V of Section 202 of the Controlled Substance Act is not Class “A” (medical). However, if there is associated harmful behavior, the applicant may be classified as Class “A” and found ineligible under INA 212(a)(1)(A)(iii).

d. (U) Clinical Care: Substances used for clinical care in medical practice are not prohibited and do not represent substance abuse.

9 FAM 302.2-8(B)(2) (U) Key Concepts

(CT:VISA-1543; 05-17-2022)

(U) In General:

(1) (U) To establish any substance-related disorder, the examining physician must document the pattern or use of the substance and behavioral, physical, and psychological effects associated with the use or cessation of the use for that substance. Diagnoses of substance-related disorders are to be made in accordance with existing medical standards as determined by the current edition of the DSM. In the current DSM, substance-related disorders are divided into the following two groups: substance-use disorders and substance-induced disorders.

(2) (U) Substance-use disorders: The essential feature of the substance use disorder is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems. The DSM criteria for substance use disorders fit within overall groupings of impaired control, social impairment, risky use, and pharmacological criteria. Pharmacological criteria include tolerance and withdrawal.

(3) (U) Substance-induced disorders: in addition to substance-use disorders, the DSM has a separate category called substance-induced disorders. The DSM list of substance-induced disorders includes but is not limited to intoxication, withdrawal, and other substance/medication-induced disorders (psychotic disorders, bipolar and related disorders, depressive disorders, anxiety disorders, obsessive-compulsive and related disorders, sleep disorders, sexual dysfunctions, delirium, and neurocognitive disorders/substance-induced psychotic disorder, and substance-induced depressive disorder).

(4) (U) The current version of the DSM defines sustained, full remission as a period of at least 12 months during which no substance use or mental disorder-associated harmful behavior have occurred. The panel physician has discretion to use their clinical judgment to determine if 12 months is an acceptable period for an individual applicant to demonstrate sustained, full remission. Remission must be considered in two contexts: (a) mental disorders and (b) substance-related disorders. For substance-related disorders for those substances listed in Schedule I though V of Section 202 of the Controlled Substances Act, the determination of remission must be made based on the applicants use and DSM criteria.

(5) (U) The practical significance for diagnosis for remission is that IV applicants who are or have been determined to be Class “A” for drug abuse or addiction for those substance listed in Schedule I though V of Section 202 of the Controlled Substances Act are not eligible for a waiver and must complete the period for sustained, full remission before reapplying for admission.

9 FAM 302.2-8(B)(3) (U) Screening

(CT:VISA-615; 07-03-2018)

(U) The medical screening for substance-related disorders is required by law and is an essential component of the medical examination of visa applicants.

9 FAM 302.2-8(B)(4) (U) Role of the Panel Physician in Evaluating Substance Related Disorders

(CT:VISA-1273; 05-04-2021)

a. (U) Technical Instructions: Panel physicians must follow the current Technical Instructions when evaluating visa applicants for physical or mental disorders with associated harmful behavior and substance related disorders.

b. (U) Medical Examination: As part of the medical examination of applicants, the panel physician will carry out or obtain a mental health evaluation:

(1) (U) To identify the use of drugs, and diagnosis any substance-related disorder; and

(2) (U) To determine the remission status of any disorder or previous diagnosis; and

c. (U) Disorder Can Be Noted at Any Time During Examination: The panel physician can recognize that an applicant with a physical or mental disorder might have associated harmful behavior during any point of the examination (while taking the medical history or a mental disorder, while taking history of harmful behavior, or while observing for current abnormal behavior during the physical examination.

d. (U) Multiple Appointments: For most applicants, the panel physician’s examination will require only one appointment. However, for some applicants multiple appointments or specialist consultations may be required to make an accurate diagnosis of whether the applicant is afflicted with a Class “A” or Class “B” condition as it related to physical or mental disorders with associated harmful behavior or substance-related disorders.

e. (U) Random Drug Screening: Random screening for drugs is not a part of the routine medical examination. The panel physician must evaluate the applicant’s history, behavior, and physical appearance, when determining if drug screening should be performed. Whole populations of applicants should not routinely be subject to random laboratory screening. The panel physician should make an individual decision based on the indications for drug screening.

9 FAM 302.2-8(B)(5) (U) Referrals to Specialists for Further Evaluation

(CT:VISA-1979; 04-25-2024)

a. (U) Required Referrals: The panel physician may refer an applicant to a specialist consultant (that is agreed upon with the consular section) if after the medical interview, review of records (including Form DS-3026) and performing a mental status and physical examination, the panel physician is not able to:

(1) (U) Arrive at a probable diagnosis of a substance-related disorder according to DSM criteria; or

(2) (U) Classify as a Class “A” or “B” condition.

b. (U) Referral to CDC: If an applicant is referred to a specialist for psychiatric evaluation and further assistance in determining the diagnosis and classification is needed, CDC’s Division of Global Migration Health (DGMH) may be consulted. If CDC/DGMH is consulted, a copy of all pertinent medical information may be sent via secure email to cdcqap@cdc.gov.

9 FAM 302.2-8(B)(6) (U) Determine Class “A” or Class “B” Substance Related Disorders

(CT:VISA-2008; 06-11-2024)

a. (U) Class A Conditions: Class “A” medical conditions render a visa applicant ineligible to receive a visa and, for mental health, include applicants who are determined by the panel physician to have drug abuse or addiction (substance-related disorder) for specific substances listed in Schedule I-V of Section 202 of the Controlled Substances Act.

c. (U) Deferring Classification: If a panel physician is unable to determine whether an applicant has a diagnosis of a substance related disorder, then classification may be deferred to obtain additional medical evidence. When this occurs, the panel physician must explain to the applicant that they would like to see the applicant during the next 3 to 6 months to determine if abstinence is present (to classify the applicant).

d. (U) Multiple Classifications: Applicants may have more than one classification. However, applicant cannot be classified both Class “A” and “B” for the same substance related disorder.

e. (U) Classifications and Descriptions: Substance-related disorders classification and description are listed below:

(1) (U) No Class “A” or Class “B” Classification: The applicant has no diagnosis of a substance related disorder.

(2) (U) Class “A” Abuse or Addiction: (for specific substances listed in Schedule I-V of Section 202 of the Controlled Substances Act);

(3) (U) Class “B” Abuse or Addiction in Full Remission: The applicant was diagnosed with full, sustained remission of substance related disorder based on current DSM criteria.

9 FAM 302.2-8(B)(7) (U) Applicants with Previous INA 212(a)(1)(A)(iv) Ineligibilities

(CT:VISA-1543; 05-17-2022)

(U) For cases previously refused under INA 212(a)(1)(A)(iv) due to a Class “A” medical finding you should take the following steps:

(1) Unavailable

(2) Unavailable

9 FAM 302.2-8(C) (U) Advisory Opinion

(CT:VISA-1247; 03-10-2021)

(U) An AO is not required for a potential INA 212(a)(1)(A)(iv) ineligibility; however, if you have a question about the interpretation or application of law or regulation, you may request an AO from L/CA. If you have question about the application of policy or procedure contact CA/VO/F.

9 FAM 302.2-8(D) (U) Waiver

9 FAM 302.2-8(D)(1) (U) Waivers for Immigrants

(CT:VISA-1543; 05-17-2022)

(U) There is no waiver relief for an IV applicant who is ineligible under INA 212(a)(1)(A)(iv). Do not issue an IV to an applicant that the panel physician identifies as a drug abuser or addicted to a drug described in Section 202 of the Controlled Substances Act.

9 FAM 302.2-8(D)(2) (U) Waivers for Nonimmigrants

(CT:VISA-1543; 05-17-2022)

a. (U) In General: If you determine that an applicant is ineligible for an NIV under INA 212(a)(1)(A)(iv), you may recommend to DHS/CBP through ARIS, that a waiver under INA 212(d)(3)(A) be granted to the applicant. DHS/CBP may, in its discretion, authorize a waiver to allow the applicant temporary admission. See 9 FAM 305.4-3(E)(1).

b. (U) Travel for Medical Reasons: The requirements listed below must be fulfilled in the case of an applicant traveling for medical treatment of a condition that leads to a finding of ineligibility under INA 212(a)(1)(A)(iv). When a waiver of a medical ground of ineligibility is deemed necessary, the applicant must establish that arrangements, including financial, have been made for treatment. When the personal resources of an applicant are not sufficient or may not be available outside the applicant's country of residence, the applicant must include explicit information regarding which facilities are available for support during the proposed medical treatment. The sponsor of the affidavit must confirm that a bond will be made available if required by the DHS.

c. (U) Use of Notations "Med" in Visa Stamp: An NIV should be annotated as indicated in the following cases:

(1) (U) When the medical examination has revealed a Class A tuberculosis or another Class A medical condition, and an INA 212(d)(3)(A) waiver has been granted, the visa should be annotated: “MED: 212(d)(3)(A).”

(2) (U) When the medical examination has revealed a Class B tuberculosis condition or Class B leprosy, non-infectious, the visa should be annotated: “MED: Class B.”

9 FAM 302.2-8(E) Unavailable

9 FAM 302.2-8(E)(1) Unavailable

(CT:VISA-2008; 06-11-2024)

Unavailable

9 FAM 302.2-8(E)(2) Unavailable

(CT:VISA-1796; 07-12-2023)

Unavailable

UNCLASSIFIED (U)