Under the authority of the Immigration and Nationality Act (INA) and the Public Health Service Act, the Secretary of Health and Human Services promulgates regulations outlining the requirements for the medical examination of aliens seeking admission into the United States. The Division of Global Migration and Quarantine provides the Department of State (DOS) and the U.S. Citizenship and Immigration Services (USCIS) with medical screening guidelines for all examining physicians, which outline in detail the scope of the medical examination. The purpose of the medical examination is to identify, for the DOS and USCIS, applicants with inadmissible health-related conditions.

A medical examination is mandatory for all refugees coming to the U.S. and all applicants outside the U.S. applying for an immigrant visa. Aliens

Outside theU.S., medical examinations are performed by approximately 400 physicians (panel physicians) selected by DOS consular officials. In the

DGMQ provides the technical instructions and guidance to physicians conducting the medical examination for immigration. These instructions are developed in accordance with Section 212(a)(1)(A) of the INA, which states those classes of aliens ineligible for visas or admission based on health-related grounds. The health-related grounds include those aliens who have a communicable disease of public health significance, who fail to present documentation of having received vaccination against vaccine-preventable diseases, who have or have had a physical or mental disorder with associated harmful behavior, and who are drug abusers or addicts.

If an immigrant or refugee has an inadmissible health-related condition, a waiver is required for the applicant to come to the United States. This is also the case for an applicant who is in the United States applying for adjustment of status to permanent residence. Section 212(g) of the INA provides for the waiver of the health-related