[Code of Federal Regulations]

[Title 42, Volume 1]

[Revised as of October 1, 2005]

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]