The medical examination demystified | Harris Beach SA

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Concerns about public health and immigration law have been linked to the United States for over 100 years. Since the Immigration Act of 1891, people seeking admission to the United States have faced potential immigration bans due to fear of communicable diseases and pandemics. In the past, this required a physical inspection at the port of entry.

The Immigration Act of 1990 provides for the current Public Health Inadmissibility Act for those seeking permanent resident status in the United States, and the Illegal Immigration Reform and Immigration Act. Immigrant responsibility in 1996 introduced a vaccination requirement. Under modern law, all applicants who apply for a green card, whether from the United States or overseas, must demonstrate that they are not inadmissible to the United States for health reasons. public by passing a government-mandated medical examination.

What is Form I-693, medical examination?

Form I-693, Medical Examination Report and Immunization Record, as the name suggests, is a report prepared by a licensed civil surgeon that includes the results of various medical examinations performed on an applicant by the civil surgeon, as well as a record of the applicant’s immunization status. USCIS uses the report to determine if the applicant is “inadmissible to the United States for reasons of public health,” which is defined by Section 212 of the Immigration and Nationality Act (“INA”) . While applicants for U.S. permanent resident status (“adjustment of status”) complete Form I-693 as part of their application process, individuals seeking an immigrant visa at a U.S. consulate in the foreigner undergo a similar medical examination by a designated physician. , completed on form DS-2054.

Under the INA, applicants can be refused permanent residence if they “have a communicable disease of public health significance” or if they have not been vaccinated against certain diseases. The current list of “communicable diseases” includes infections such as tuberculosis, leprosy, gonorrhea and others. The Secretary of Health and Social Services has the discretion to expand this list to include anyone considered to have a “communicable disease of public health importance”.

The examination performed by the civilian surgeon / designated physician includes a physical examination, blood tests and specific tests for tuberculosis, including a skin test and an x-ray. These exams are used to determine if an applicant has any of the “communicable diseases” listed above.

Applicants should also be vaccinated against certain diseases, including: (1) mumps, (2) measles, (3) rubella, (4) polio, (5) tetanus and diphtheria, (6) whooping cough , (7) haemophilus influenzae type B, (8) hepatitis A, (9) hepatitis B, (10) rotavirus, (11) meningococcal disease, (12) chickenpox and (13) pneumococcal disease. The list may be expanded to include any other vaccinations recommended by the Advisory Committee on Immunization Practices – and was in fact recently expanded to include COVID-19 (see below). A waiver of the vaccination requirement may be required if an applicant is unable to receive the required vaccines for medical reasons, or an individual waiver may be requested if an applicant objects to all vaccinations in any form. whether on the basis of religious beliefs or moral convictions. These waivers of inadmissibility will be addressed in a future article on this blog.

In addition to these requirements, applicants may also be declared inadmissible if it is determined that they suffer from a physical or mental disorder associated with behavior that poses a threat to the property, safety or well-being of the applicant. or other persons, or if the applicant is determined to be a drug addict.

Recent changes to the medical examination

Typically, Form I-693 medical examinations performed in the United States are valid for two years from the date they are signed by the civil surgeon. If the medical examination is completed before an applicant submits their request for an I-485 adjustment of status, the medical examination must be submitted to USCIS within 60 days of being signed by the civilian surgeon. On August 12, 2021, USCIS announced that the validity period for Form I-693 reports would be temporarily extended from two to four years. This change was made to address ongoing processing delays caused by the COVID-19 pandemic. This temporary extension is expected to end on September 30, 2021, so all medical examinations submitted after September 30 will again have a two-year validity period.

The most recent change to medical examination requirements is that effective October 1, 2021, all applicants for permanent resident status in the United States, whether applying for a United States immigrant visa or in a US Consulate, will need proof of a COVID-19 Vaccination. For vaccinations requiring two doses, such as Pfizer and Moderna, an applicant is not deemed to be vaccinated until after receiving both doses. This requirement applies prospectively to all I-693 forms signed by the civil surgeon as of this date. USCIS said general waivers may be available in situations where COVID-19 vaccine is not age appropriate, contraindicated due to a medical issue, is not routinely available there where the civilian surgeon is practicing, or is limited in supply and would cause a significant delay for the applicant to receive the vaccine.

How / when do I submit the medical examination?

For adjustment of status applicants in the United States, although the medical examination is a mandatory part of the green card process, it is not necessary to submit it in advance with the Form I-485 request. . The completed medical examination may be submitted with the Form I-485 request, but it is also permissible to submit it at a later stage of the process (in response to a USCIS proof request (“RFE”) or in person during an interview if necessary ).

USCIS recently updated its instructions on how to submit a Form I-693 if it is filed after the status request has been adjusted. Applicants will receive a notice in the mail from USCIS after submitting their application, titled “Form I-693 Medical Exam Reminder”. This reminder encourages applicants to submit their Form I-693 to USCIS upon receipt of the reminder. This is a recent change, as USCIS previously recommended submitting Form I-693 at a later stage, either after the applicant receives a formal RFE or during their interview. If an applicant chooses to follow the notice’s instructions, they should include a copy of their recall notice with their Form I-693 submission, as this will ensure that USCIS correctly connects the Form I-693 to their request for it. ‘status adjustment pending. Alternatively, the applicant can always file their Form I-693 at a later stage, either during their interview or after receiving an RFE.

What is the best option for submitting a medical exam?

USCIS recommends completing Form I-693 at the same time as Form I-485 (Green Card Application), as this will eliminate the need for USCIS to issue a subsequent Request for Evidence (RFE) for the form. I-693. According to USCIS, submitting the two together can help them process the request faster.

In previous years, there was a greater risk that the Form I-693 would expire before USCIS could process an adjustment of status, making concurrent filing not recommended. Due to USCIS processing delays, it was common for Form I-693 to expire before the green card application was processed, resulting in USCIS issuing an RFE for a new report. medical examination, which caused candidates to waste time and unnecessary money. Now, with the two-year validity period – and the temporary four-year validity period for those submitted before September 30, 2021 – many applicants may wish to file the report along with the I-485 form to avoid delays. on the back end. of their green card processing.


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