Chapter 3 - Blanket Civil Surgeon Designation
A. Blanket Designation of State and Local Health Departments[1]
1. Overview
USCIS has the authority to designate either individual physicians or members of a specified class of physicians as civil surgeons, provided they meet the legal requirements.[2] Through policy and in agreement with the Centers for Disease Control and Prevention (CDC), USCIS designated all state and local health departments as civil surgeons. Health departments may only use this blanket civil surgeon designation to complete the vaccination assessments for refugees seeking adjustment of status.[3]
This blanket designation eases the difficulties encountered by refugee adjustment applicants in complying with the vaccination requirement. It also relieves USCIS of the need to maintain lists of health departments and the names of individual physicians at these health departments.
2. Eligible Physicians
Participation in this blanket civil surgeon designation is entirely voluntary and at the discretion of each health department. Health departments may only participate under this blanket designation if they have physicians authorized to provide medical services who meet the professional qualifications of a civil surgeon[4] since only these qualifying physicians may certify the vaccination assessment for refugees seeking adjustment of status. This includes volunteer physicians at state and local health departments.
Eligible physicians at health departments may, but are not required to, personally perform the vaccination assessment. Nurses or other medical professionals may perform the vaccination assessment and complete the vaccination record in the Report of Immigration Medical Examination and Vaccination Record (Form I-693) as long as the health department physician reviews and certifies the Form I-693.
Neither health departments nor eligible physicians at health departments need to obtain approval from USCIS prior to performing the vaccination component of immigration medical examinations as specified in the next section. Blanket designated civil surgeons are exempt from both application and fee requirements for civil surgeon designation.
However, health departments and eligible physicians must review and be familiar with the Technical Instructions for the vaccination requirements before they can begin performing vaccination assessments.[5]
3. Scope
Pursuant to the understanding reached between USCIS and CDC, health departments may only use this blanket civil surgeon designation to complete the vaccination assessments for refugees seeking adjustment of status.[6] Therefore, health departments operating under this blanket designation should examine government-issued documents presented by the applicant to verify that he or she is a refugee.[7] This blanket designation does not cover asylees seeking adjustment of status.[8]
Accordingly, health departments operating under this blanket designation are authorized only to perform the vaccination component of the immigration medical examination for refugees seeking adjustment of status. If a health department physician would like to perform parts of the immigration medical examination other than the vaccination assessment, the physician must obtain designation as a civil surgeon through the standard application process.[9]
Refugees who require the entire medical exam,[10] likewise need to visit a physician designated as a civil surgeon through the standard application process.[11]
4. Recording and Certification Requirements
Health departments operating under the blanket civil surgeon designation must record the vaccination assessment on the Report of Immigration Medical Examination and Vaccination Record (Form I-693) as follows:
- Ensure the applicant’s information and certification are completed;
- Complete the vaccination record; and
- Complete the civil surgeon’s information and certification.
In accordance with the agreements reached with CDC, health departments operating under the blanket civil surgeon designation are required to certify Form I-693 by providing the attending physician’s signature and a seal or stamp of the health department:
Physician Signature
The attending physician must sign Form I-693. A signature stamp may be used. Health department nurses or other health care professionals may, but are not required to, co-sign the form. However, a form that has been signed only by a registered nurse, physician's assistant, or other medical professional who is not a licensed physician is not sufficient.
If a form for a refugee adjusting status has been signed only by a medical professional employed by the health department (without an accompanying signature by a medical doctor), a Request for Evidence (RFE) should be sent to the applicant for corrective action.
Health Department Stamp or Seal
The health department is also required to affix either the official stamp or raised seal (whichever is customarily used) of that health department on the space designated on the form.
As with all immigration medical examinations, the signed Form I-693 must be placed in a sealed envelope, according to the form’s instructions.
B. Blanket Designation of Military Physicians as Civil Surgeons
1. Overview
USCIS, in consultation with CDC, has authorized a blanket civil surgeon designation to military physicians for the completion of all parts of a required immigration medical examination for members and veterans of the U.S. armed forces, and certain dependents who are eligible to receive medical care from military physicians at military treatment facilities (MTFs).
Effective July 26, 2021, USCIS is extending this blanket civil surgeon designation to allow military physicians to also complete the immigration medical examination for certain Afghan nationals seeking a special immigrant visa, including both principal applicants and eligible family members, in coordination with Operation Allies Refuge.[12]
This blanket civil surgeon designation recognizes the service and sacrifices made by U.S. armed forces members and veterans, as well as translators, interpreters, and other professionals employed by or on behalf of the U.S. government in Afghanistan and their eligible dependents. It also eases the difficulties these persons may encounter in obtaining the required immigration medical examination in the United States. The blanket civil surgeon designation also facilitates the civil surgeon designation process for military physicians and relieves USCIS of the need to maintain lists of individual military physicians designated as civil surgeons.
2. Eligible Physicians
Participation in this blanket civil surgeon designation is entirely voluntary and at the discretion of each medical facility. This blanket designation only applies to military physicians who:
- Meet the professional qualifications of a civil surgeon[13] except that the physician may be licensed in any state in the United States, and is not required to be licensed in the state in which the physician is performing the immigration medical examination;
- Are employed by the Department of Defense (DOD) or provides medical services to U.S. armed forces members, veterans, and their dependents as military contract providers or civilian physicians; and
- Are authorized to provide medical services at a military treatment facility (MTF) within the United States.
Neither the medical facility nor the physician who qualifies and wishes to participate in the blanket designation needs to obtain approval from USCIS prior to performing immigration medical examinations as specified in the next section. Blanket designated civil surgeons are exempt from both USCIS application and fee requirements for civil surgeon designation.
However, military physicians must review and be familiar with CDC’s Technical Instructions for the Medical Examination of Aliens in the United States before they can begin performing immigration medical examinations.[14]
3. Scope
Pursuant to the understanding reached between USCIS and CDC, military physicians only qualify under this blanket civil surgeon designation when two conditions are met. First, the examination must be conducted in the United States at an MTF or other location where the military physician may be authorized to examine Afghan nationals in coordination with Operation Allies Refuge. Second, the immigration medical examination is being conducted for:
- A U.S. armed forces member or veteran;
- A dependent of a U.S. armed forces member or veteran who is eligible to receive medical care at an MTF; or
- Certain Afghan nationals seeking a special immigrant visa, including both principal applicants and eligible family members, in coordination with Operation Allies Refuge.
If these two conditions are not met, military physicians are not covered under this blanket designation and must apply for civil surgeon designation under the standard designation process[15] in order to perform immigration medical examinations.
U.S. armed forces members, veterans, or dependents must visit a physician designated as a civil surgeon through the standard application process if they:
- Prefer to have the immigration medical examination performed by a physician who does not qualify under this blanket designation for military physicians;
- Prefer to have the immigration medical examination performed in a U.S. location other than at the MTF at which they are authorized to receive medical services (or other authorized location under this blanket designation for military physicians); or
- Do not have access to a military physician who is performing immigration medical examinations under this blanket designation.
4. Recording and Certification Requirements
Military physicians operating under the blanket civil surgeon designation must record the results of the immigration medical examination on the Report of Immigration Medical Examination and Vaccination Record (Form I-693), according to the standard procedures all civil surgeons are required to follow.
In accordance with the agreements reached with CDC, a military physician operating under the blanket civil surgeon designation is required to certify Form I-693 by providing both of the following on the form:
Physician Signature
The blanket designated civil surgeon must sign Form I-693. A signature stamp may be used. Nurses or other health care professionals may, but are not required to, co-sign the form. However, a form that has been signed only by a registered nurse, physician's assistant, or other medical professional who is not a licensed physician is not sufficient. If a form for a U.S. armed forces member, veteran, or eligible dependent has been signed only by a medical professional employed by the military facility (without an accompanying signature by a medical doctor), an RFE should be sent to the applicant for corrective action.
MTF Stamp or Seal
The MTF is also required to affix either the official stamp or raised seal of that facility on the space designated on the form.
The signed Form I-693 must be placed in a sealed envelope, according to the form’s instructions.
Footnotes
[^ 2] As specified under INA 232(b), 8 CFR 232.2(b), and 42 CFR 34.2(c).
[^ 4] As described in Chapter 1, Purpose and Background, Section C, Professional Qualifications [8 USCIS-PM C.1(C)].
[^ 5] The Technical Instructions are available online at: cdc.gov/immigrant-refugee-health/hcp/civil-surgeons/vaccination.html.
[^ 7] Refugees may present their Arrival-Departure Record (Form I-94), Refugee Travel Document (Form I-571), or Employment Authorization Document (Form I-766) as evidence of refugee status. However, health departments completing the vaccination assessment will not know whether a refugee seeks adjustment under INA 209 or under another provision. Therefore, when reviewing a vaccination assessment completed by a blanket designated civil surgeon for a refugee seeking adjustment, the officer should confirm that the refugee is adjusting under INA 209 before accepting the vaccination assessment performed by a blanket designated health department.
[^ 9] As outlined in Chapter 2, Application for Civil Surgeon Designation [8 USCIS-PM C.2].
[^ 10] See 8 CFR 209.1(b).
[^ 11] However, blanket-designated health departments may still perform the vaccination component of the medical exam for refugees who require the entire medical exam.
[^ 12] See U.S. Embassy in Afghanistan’s Operation Allies Refuge webpage. See Section 602(b) of the Afghan Allies Protection Act of 2009, Title VI of Pub. L. 111-8 (PDF), 123 Stat. 524, 807 (March 11, 2009). See Section 1059 of the National Defense Authorization Act for Fiscal Year 2006, Pub. L. 109-163 (PDF), 119 Stat. 3136, 3443 (January 6, 2006). For more information, see Volume 6, Immigrants, Part H, Designated and Special Immigrants, Chapter 9, Certain Afghan Nationals [6 USCIS-PM H.9] and Chapter 10, Certain Iraqi and Afghan Translators and Interpreters [6 USCIS-PM H.10]; and Volume 7, Adjustment of Status, Part F, Special Immigrant-Based Adjustment, Chapter 9, Certain Broadcasters [7 USCIS-PM F.9] and Chapter 10, Certain Afghan and Iraqi Nationals [7 USCIS-PM F.10].
[^ 13] As described in Chapter 1, Purpose and Background, Section C, Professional Qualifications [8 USCIS-PM C.1(C)].
[^ 14] The Technical Instructions are available online at: cdc.gov/immigrant-refugee-health/hcp/civil-surgeons/index.html.
[^ 15] As outlined in Chapter 2, Application for Civil Surgeon Designation [8 USCIS-PM C.2].