Introduction

When it comes to immigrating to the United States, one essential step that many applicants must complete is the immigration medical examination. This crucial exam is performed by a USCIS-designated civil surgeon, an authorized physician who ensures that applicants meet the health requirements set by U.S. law. The civil surgeon’s role is not just a formality, it protects public health by screening for communicable diseases and other health conditions that could affect eligibility for immigration benefits. Understanding who these civil surgeons are and what they do helps applicants navigate this important part of the immigration process with confidence.

Historical Background and Legal Authority

Before diving into the role of civil surgeons, it’s important to clarify a key term, in U.S. immigration law, an alien is any person who is not a U.S. citizen or national but seeks admission or status in the United States. The requirement for medical examinations of aliens dates back to the Immigration Act of 1882, which aimed to prevent the entry of individuals who might become public charges due to poor health or inability to care for themselves.

By 1891, the term “civil surgeon” was introduced as part of the Immigration Act to address a practical challenge, Marine Hospital Service surgeons, who originally conducted these exams, were not always available or accessible to immigrants. This led to the authorization of licensed private physicians, civil surgeons, to perform these medical examinations, expanding capacity and accessibility.

Today, the Immigration and Nationality Act (INA) of 1952, as amended by the Homeland Security Act of 2002, empowers the Secretary of Homeland Security to designate qualified physicians as civil surgeons when U.S. Public Health Service officers are unavailable. This legal framework ensures that nearly all immigration medical exams in the U.S. are performed by designated civil surgeons, maintaining consistent public health standards.

Who is a USCIS-Designated Civil Surgeon?

A USCIS-designated civil surgeon is a licensed physician, either a Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.O.), who meets specific professional criteria. To qualify, a physician must have at least four years of professional medical experience after completing all postgraduate training (internships and residencies do not count toward this requirement). They must also hold an unrestricted medical license in the state where they conduct immigration medical exams.

Physicians interested in becoming civil surgeons must apply using Form I-910, Application for Civil Surgeon Designation, which remains the official and current application form as of 2025. Since 2014, USCIS has centralized the designation process to ensure uniform standards and oversight.

It’s important for applicants to verify that their chosen doctor is officially designated. USCIS maintains a publicly accessible “Find a Civil Surgeon” online tool where applicants can confirm a physician’s current civil surgeon status before scheduling their exam. This verification step helps avoid delays caused by exams performed by unauthorized providers.

Primary Responsibilities of Civil Surgeons

Civil surgeons carry significant responsibilities to uphold public health and immigration law. Their primary duty is to perform immigration medical examinations according to the Technical Instructions for Civil Surgeons, published and regularly updated by the Centers for Disease Control and Prevention (CDC). These instructions detail the examination components, required vaccinations, laboratory tests, and reporting procedures.

Key responsibilities include:

• Conducting thorough medical and mental health assessments to identify any health conditions that could render an applicant inadmissible, such as communicable diseases (e.g., tuberculosis, syphilis), drug abuse, or mental disorders linked to harmful behavior.
• Administering required vaccinations based on CDC guidelines.
• Completing and accurately filling out Form I-693, Report of Immigration Medical Examination and Vaccination Record, which is submitted to USCIS as part of the immigration application.
• Referring applicants for treatment if a disqualifying condition is detected (civil surgeons do not provide treatment themselves).
• Reporting any changes in their contact information to USCIS within 15 days.
• Ceasing immigration medical examinations if their civil surgeon designation is revoked and informing affected patients.

Failure to comply with these responsibilities can lead to revocation of the civil surgeon’s designation, emphasizing the importance of adherence to regulations.

The Medical Examination Process Explained

The immigration medical examination is a structured process designed to evaluate an applicant’s health comprehensively:

• Identity Verification: 

The civil surgeon first confirms the applicant’s identity to prevent fraud.

• Medical History Review: 

This includes questions about past hospitalizations, illnesses, psychiatric conditions, drug use, and any history of harmful behavior. The surgeon may also review relevant records such as police or school reports if available.

• Physical and Mental Examination: 

The surgeon conducts a detailed examination to detect any Class A (inadmissible) or Class B (significant but not disqualifying) health conditions. Class A conditions include communicable diseases of public health significance and other serious health issues.

• Vaccinations: 

The surgeon administers required vaccines according to CDC schedules, including updates like COVID-19 vaccination requirements.

• Laboratory Tests: 

Tests such as chest X-rays for tuberculosis or blood tests for syphilis are performed as needed.

If the applicant is found to have a Class A condition, they may initially be deemed inadmissible but can overcome this by completing treatment or obtaining a waiver. The civil surgeon reports all findings on Form I-693, which USCIS reviews to make admissibility determinations.

Health-Related Grounds of Inadmissibility and Overcoming Them

When applying for immigration benefits, certain health conditions can make an applicant inadmissible to the United States. These are known as health-related grounds of inadmissibility, defined primarily under section 212(a)(1) of the Immigration and Nationality Act (INA). The four main categories include:

• Communicable diseases of public health significance, such as tuberculosis or syphilis.
• Failure to show proof of required vaccinations against vaccine-preventable diseases.
• Physical or mental disorders associated with harmful behavior, which could pose a danger to others.
• Drug abuse or addiction.

If an applicant is found to have one of these conditions, it does not necessarily mean the end of their immigration journey. Many health-related inadmissibilities can be overcome. For example, communicable diseases like tuberculosis or syphilis can often be treated successfully. Once treatment is complete and the applicant is no longer contagious, they may be re-evaluated and considered admissible.

Vaccination requirements must be met unless the applicant qualifies for a medical exemption. Additionally, in some cases, applicants can apply for a waiver of inadmissibility by filing Form I-601. This waiver allows USCIS to forgive certain health-related grounds if the applicant meets specific criteria, such as demonstrating extreme hardship to a U.S. citizen or lawful permanent resident family member.

It’s important to be honest during the medical examination. Concealing or lying about physical or mental conditions can lead to serious consequences beyond delays, including denial of immigration benefits, removal proceedings, or permanent inadmissibility. Transparency ensures the process moves forward fairly and legally.

What Happens if an Applicant is Diagnosed with One or More Diseases?

If a civil surgeon diagnoses an applicant with a medical condition that could affect admissibility, here’s what typically happens:

• The civil surgeon records the findings on Form I-693 and informs the applicant.
• The applicant is referred to a specialist or treatment provider for further evaluation and care, as civil surgeons do not provide treatment themselves.
• The applicant must complete any required treatment or follow-up care. For example, if diagnosed with active tuberculosis, the applicant must undergo and complete a CDC-approved treatment regimen.
• After treatment, the applicant may need to return to the civil surgeon or a panel physician to demonstrate that the condition has been resolved or controlled.
• If the condition is successfully treated or managed, the applicant’s medical inadmissibility may be lifted, allowing USCIS to approve their immigration application.
• If the condition cannot be treated or controlled, or if the applicant refuses treatment, USCIS may deny the application based on health grounds.

In some cases, applicants with certain conditions may be eligible for waivers or exemptions, but these require additional applications and USCIS review.

Importance of the Civil Surgeon Role in Immigration and Public Health

Civil surgeons play a critical role at the intersection of immigration and public health. By carefully screening immigrants for communicable diseases and other health risks, they help protect the broader U.S. population from potential outbreaks and health hazards.

Their examinations ensure that immigrants meet the health standards necessary for lawful admission, supporting national security and public safety. Without this medical screening, contagious diseases could spread more easily, and individuals with untreated serious health conditions might face challenges that affect their ability to integrate and thrive.

Moreover, civil surgeons help USCIS make informed decisions by providing accurate, thorough medical reports. This protects both the immigrant community and the public at large, balancing humanitarian goals with health safeguards.

Accountability and Recent Trends (Up to 2025)

Civil surgeons must strictly adhere to USCIS and CDC guidelines. Their designation can be revoked if they fail to comply with regulations, submit incomplete or inaccurate reports, or otherwise neglect their duties.

Since 2014, USCIS has centralized the civil surgeon designation process to maintain quality control and consistency nationwide. The use of standardized forms like Form I-693 and electronic submission systems has improved accuracy and processing speed.

Recent years have seen updates to vaccination requirements, including COVID-19 vaccines, reflecting evolving public health challenges. Civil surgeons must stay current with these changes to ensure compliance.

Additionally, some physicians receive blanket designations, such as military doctors or those in state and local health departments, to assist with refugee and special immigrant cases, enhancing capacity and efficiency.

Conclusion

The USCIS-designated civil surgeon is a vital figure in the U.S. immigration system, serving as both a gatekeeper and protector of public health. Through thorough medical examinations, adherence to CDC guidelines, and accurate reporting, civil surgeons help ensure that immigrants meet health-related eligibility requirements while safeguarding the American public.

For applicants, understanding the role of civil surgeons, being honest during examinations, and following through on any required treatment or vaccination is essential to a smooth immigration process. As immigration and public health policies continue to evolve, the civil surgeon’s role remains indispensable in balancing individual opportunity with collective safety.