Newly Arrived Immigrants & Refugees

More than 1 million immigrants obtained legal permanent resident status in the United States during fiscal year (FY) 2016 (October 2015–September 2016). There were 5,378 children adopted internationally and 84,989 refugees admitted into the United States during FY 2016. In addition, more than 6 million people entered the United States as nonimmigrant, long-term visitors (including students, temporary workers, and exchange visitors staying longer than 6 months). Some will likely require some form of health care during their stay. US health care professionals are therefore very likely to interact with foreign-born people at some time in their career.

The Immigration and Nationality Act (INA) mandates that all immigrants and refugees undergo a medical screening examination to identify inadmissible health conditions. An authorized panel physician in the applicant’s country of origin is responsible for performing the screening examination before departure. Applicants who adjust their immigration status after arriving in the United States undergo a medical screening by a civil surgeon.

A panel physician is a medical doctor practicing outside the United States who has an agreement with a US embassy or consulate general to conduct preimmigration medical screening examinations; >600 panel physicians perform these examinations internationally. A civil surgeon is a US physician authorized by US Citizenship and Immigration Services (USCIS) to perform official immigration medical examinations required for the adjustment of status after arrival in the United States (the process of becoming a permanent US resident). The CDC Division of Global Migration and Quarantine (DGMQ) issues Technical Instructions to panel physicians and civil surgeons and monitors the quality of the premigration medical examination process.

CDC also issues recommendations for premigration health interventions for special populations, such as refugees (see www.cdc.gov/immigrantrefugeehealth/guidelines/overseas/overseas-guidelines.html). Recommended health interventions (such as treatment for parasitic diseases) are not required under the INA but may be implemented based on level of risk in the origin country.

Although refugees are not required by federal regulations to undergo a repeat medical examination upon arrival in the United States, systems are in place in all states for refugees to receive a health assessment shortly after arrival. CDC’s screening guidelines for newly arrived refugees are available at www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/domestic-guidelines.html. Specific protocols may vary by state and are usually available on the websites of the departments of health in the state or region. Any qualified health professional may conduct the health assessment, usually in coordination with resettlement volunteer agencies and local health departments.

In many other cases, health care providers in the United States have medical encounters with migrants who have not received any sort of formal predeparture medical screening examination. These individuals do not hold an immigrant or refugee visa and fall into other categories of temporary visitors and undocumented migrants.