[Code of Federal Regulations]
[Title 42, Volume 1]
[Revised as of October 1, 2003]
From the U.S. Government Printing Office via GPO Access
[CITE: 42CFR34.3]

[Page 108-109]
 
                         TITLE 42--PUBLIC HEALTH
 
    CHAPTER I--PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN 
                                SERVICES
 
PART 34--MEDICAL EXAMINATION OF ALIENS--Table of Contents
 
Sec. 34.3  Scope of examinations.

    (a) General. In performing examinations, medical examiners shall 
consider those matters that relate to:
    (1) A communicable disease of public health significance;
    (2)(i) A physical or mental disorder and behavior associated with 
the disorder that may pose, or has posed, a threat to the property, 
safety, or welfare of the alien or others;
    (ii) A history of a physical or mental disorder and behavior 
associated with the disorder, which behavior has posed a threat to the 
property, safety, or welfare of the alien or others and which behavior 
is likely to recur or lead to other harmful behavior;
    (3) Drug abuse or addiction; and
    (4) Any other physical abnormality, disease, or disability serious 
in degree or permanent in nature amounting to a substantial departure 
from normal well-being.

The scope of the examination shall include any laboratory or additional 
studies that are deemed necessary, either as a result of the physical 
examination or pertinent information elicited from the alien's medical 
history, for the examining physician to reach a conclusion about the 
presence or absence of a physical or mental abnormality, disease, or 
disability.
    (b) Persons subject to requirement for chest X-ray examination and 
serologic testing. (1) Except as provided in paragraph (b)(1)(v) of this 
section, a chest X-ray examination, serologic testing for syphilis and 
serologic testing for HIV of persons 15 years of age and older shall be 
required as part of the examination of:
    (i) Applicants for immigrant visas;
    (ii) Students, exchange visitors, and other applicants for a 
nonimmigrant visa who are required by a consular authority to have a 
medical examination;
    (iii) Aliens outside the United States who apply for refugee status;
    (iv) Applicants in the United States who apply for adjustment of 
status under the immigration statute and regulations;
    (v) Exceptions. Neither a chest X-ray examination nor serologic 
testing for syphilis and HIV shall be required if the alien is under the 
age of 15. Provided, a tuberculin skin test shall be required if there 
is evidence of contact with a person known to have tuberculosis or other 
reason to suspect tuberculosis, and a chest X-ray examination shall be 
required in the event of a positive tuberculin reaction, and serologic 
testing where there is reason to suspect infection with syphilis or HIV. 
Additional exceptions to the requirement for a chest X-ray examination 
may be authorized for good cause upon application approved by the 
Director.
    (2) Tuberculin skin test examination. (i) All aliens 2 years of age 
or older in the United States who apply for adjustment of status to 
permanent residents, under the immigration laws and regulations, or 
other aliens in the United States who are required by the INS to have a 
medical examination in connection with a determination of their 
admissibility, shall be required to have a tuberculin skin test. 
Exceptions to this requirement may be authorized for good cause upon 
application approved by the Director. In the event of a positive 
tuberculin reaction, a chest X-ray examination shall be required. If the 
chest radiograph is consistent with tuberculosis, the alien shall be 
referred to the local health authority for evaluation. Evidence of this 
evaluation shall be provided to the civil surgeon before a medical 
notification may be issued.
    (ii) Aliens less than 2 years old shall be required to have a 
tuberculin skin test if there is evidence of contact with a person known 
to have tuberculosis or other reason to suspect tuberculosis. In the 
event of a positive tuberculin reaction, a chest X-ray examination shall 
be required. If the chest radiograph is consistent with tuberculosis, 
the alien shall be referred to the local health authority for 
evaluation. Evidence of this evaluation shall be provided to the

[[Page 109]]

civil surgeon before a medical notification may be issued.
    (3) Sputum smear examination. All aliens subject to the chest X-ray 
examination requirement and for whom the radiograph shows an abnormality 
consistent with pulmonary tuberculosis shall be required to have a 
sputum smear examination for acid-fast bacilli.
    (4) How and where performed. All chest X-ray films used in medical 
examinations performed under the regulations in this part shall be large 
enough to encompass the entire chest (approximately 14 by 17 inches; 
35.6x43.2 cm.). Serologic testing for HIV shall be a sensitive and 
specific test, confirmed when positive by a test such as the Western 
blot test or an equally reliable test. For aliens examined abroad, the 
serologic testing for HIV must be completed abroad, except that the 
Attorney General after consultation with the Secretary of State and the 
Secretary of Health and Human Services may in emergency circumstances 
permit serologic testing of refugees for HIV to be completed in the 
United States.
    (5) Chest X-ray, laboratory, and treatment reports. The chest X-ray 
reading and serologic test results for syphilis and HIV shall be 
included in the medical notification. When the medical examiner's 
conclusions are based on a study of more than one chest X-ray film, the 
medical notification shall include at least a summary statement of 
findings of the earlier films, followed by a complete reading of the 
last film, and dates and details of any laboratory tests and treatment 
for tuberculosis.
    (c) Procedure for transmitting records. For aliens issued immigrant 
visas, the medical notification and chest X-ray film, if any, shall be 
placed in a separate envelope which shall be sealed and attached to the 
alien's visa in such a manner as to be readily detached at the U.S. port 
of entry. When more than one chest X-ray film is used as a basis for the 
examiner's conclusions, all films shall be included.
    (d) Failure to present records. When a determination of 
admissibility is to be made at the U.S. port of entry, a medical hold 
document shall be issued pending completion of any necessary examination 
procedures. A medical hold document may be issued for aliens who:
    (1) Are not in possession of a valid medical notification, if 
required;
    (2) Have a medical notification which is incomplete;
    (3) Have a medical notification which is not written in English;
    (4) Are suspected to have an excludable medical condition.
    (e) The Attorney General, after consultation with the Secretary of 
State and the Secretary of Health and Human Services, may in emergency 
circumstances permit the medical examination of refugees to be completed 
in the United States.
    (f) All medical examinations shall be carried out in accordance with 
such technical instructions for physicians conducting the medical 
examination of aliens as may be issued by the Director. Copies of such 
technical instructions are available upon request to the Director, 
Division of Quarantine, Mailstop E03, CDC, Atlanta GA 30333.

[56 FR 25002, May 31, 1991]