USCIS Case Studies & Practical Application 4 — Questions and Answers
Question 1: A 55-year-old applicant needs a hepatitis B vaccine series as part of the I-693 requirements, but has documented anaphylaxis to a prior hepatitis B vaccine dose. How should the civil surgeon handle this?
- Administer the next dose under close observation in the office
- Document the severe allergic reaction as a medical contraindication on the I-693 and do not administer the vaccine (Correct answer)
- Refer the applicant to an allergist for desensitization before completing the I-693
- Mark the vaccination as 'refused' and advise the applicant to file a waiver independently
Correct answer: Document the severe allergic reaction as a medical contraindication on the I-693 and do not administer the vaccine
A history of anaphylaxis to a vaccine component is a contraindication recognized by the CDC; the civil surgeon documents this on the I-693 rather than administering the vaccine.
Question 2: An applicant for adjustment of status has a positive gonorrhea NAAT result discovered during the I-693 exam. The applicant received a single-dose azithromycin and ceftriaxone treatment in the civil surgeon's office. Can the I-693 be signed the same day?
- Yes, gonorrhea is not a Class A condition so it does not affect the I-693 completion date
- No, gonorrhea is a Class A condition; the civil surgeon should confirm treatment was given and note it, then sign the I-693 after confirming treatment completion (Correct answer)
- No, the applicant must wait 30 days and provide a test-of-cure before the I-693 can be signed
- Yes, same-day signing is permitted but the applicant must follow up with their own physician for confirmation
Correct answer: No, gonorrhea is a Class A condition; the civil surgeon should confirm treatment was given and note it, then sign the I-693 after confirming treatment completion
Gonorrhea is a Class A communicable disease; the civil surgeon must document treatment and confirm it was administered before certifying the I-693.
Question 3: A civil surgeon's USCIS designation is about to expire in 30 days. An applicant schedules an exam for a date after the expiration. The civil surgeon's designation lapses before the appointment. What happens if the civil surgeon completes the I-693 after the designation expires?
- The I-693 is still valid as long as the civil surgeon was designated at some point in the past
- USCIS will reject the I-693 as invalid because only currently designated civil surgeons may sign the form (Correct answer)
- The I-693 is valid if the civil surgeon files for re-designation within 60 days of signing
- The applicant may petition USCIS to accept the expired-designation I-693 on a case-by-case basis
Correct answer: USCIS will reject the I-693 as invalid because only currently designated civil surgeons may sign the form
The civil surgeon must be currently designated by USCIS at the time of signing; an expired designation invalidates the I-693 and requires a new exam from an active civil surgeon.
Question 4: An applicant's overseas panel physician exam identified a Class A tuberculosis condition. The applicant was treated abroad and arrives in the US with documentation of completed treatment. Which agency conducts the domestic follow-up evaluation?
- USCIS schedules the follow-up appointment at a field office
- The local or state health department conducts the required follow-up under CDC's domestic medical examination program for refugees and immigrants with Class A conditions (Correct answer)
- The applicant's personal physician certifies treatment completion directly to USCIS
- A civil surgeon performs a new I-693 immediately upon arrival at the port of entry
Correct answer: The local or state health department conducts the required follow-up under CDC's domestic medical examination program for refugees and immigrants with Class A conditions
The CDC's Division of Global Migration Health coordinates with state and local health departments to conduct follow-up evaluations for arriving immigrants with Class A conditions.
Question 5: During an I-693 exam, an applicant discloses they were hospitalized involuntarily for a psychiatric condition 15 years ago after a single episode, have had no recurrences, and are currently employed and stable. How does the civil surgeon most appropriately handle this?
- Classify as Class A because any history of involuntary psychiatric hospitalization is permanently disqualifying
- Evaluate the current mental health status; if there is no current mental disorder associated with harmful behavior, no Class A finding is warranted (Correct answer)
- Require a current psychiatric evaluation from a board-certified psychiatrist before completing the I-693
- Classify as Class B and recommend the applicant seek immigration counsel before proceeding
Correct answer: Evaluate the current mental health status; if there is no current mental disorder associated with harmful behavior, no Class A finding is warranted
The inadmissibility standard requires a current mental disorder associated with harmful behavior; a remote single episode with full recovery does not automatically result in a Class A finding.
Question 6: A refugee applicant completed an overseas medical exam 18 months ago with a CDC-designated panel physician. Upon resettlement, she is referred for a domestic medical exam. Which of the following is TRUE about vaccine requirements at the domestic exam?
- Vaccines administered overseas by the panel physician do not count; the full series must be restarted domestically
- Vaccines documented on the overseas DS-3025 and DS-3026 forms are accepted and the civil surgeon documents them rather than re-administering (Correct answer)
- Only vaccines administered in the US by an approved provider are accepted by USCIS
- The domestic civil surgeon has discretion to accept or reject overseas vaccine records based on country of origin
Correct answer: Vaccines documented on the overseas DS-3025 and DS-3026 forms are accepted and the civil surgeon documents them rather than re-administering
Vaccines documented on the overseas panel physician forms (DS-3025/DS-3026) are accepted as valid; the domestic civil surgeon records them on the I-693 without re-administering.
Question 7: An applicant has a documented allergy to eggs and is concerned about receiving the influenza vaccine. The civil surgeon is completing the I-693 during flu season. What is the correct approach?
- Exempt the applicant from influenza vaccination permanently due to the egg allergy
- Administer an FDA-approved recombinant or cell-based influenza vaccine that does not contain egg proteins, or follow current CDC guidance for egg allergy management (Correct answer)
- Defer the influenza vaccine and note it as pending; egg allergy prevents any influenza vaccination
- Refer the applicant to an allergist and delay the I-693 until allergy testing is complete
Correct answer: Administer an FDA-approved recombinant or cell-based influenza vaccine that does not contain egg proteins, or follow current CDC guidance for egg allergy management
Current CDC guidance states that most egg-allergic individuals can receive standard influenza vaccines; egg-free alternatives exist and should be used when indicated.
USCIS Case Studies & Practical Application 4
A 55-year-old applicant needs a hepatitis B vaccine series as part of the I-693 requirements, but has documented anaphylaxis to a prior hepatitis B vaccine dose.
How should the civil surgeon handle this?