USCIS Case Studies & Practical Application 5 — Questions and Answers
Question 1: A civil surgeon completes an I-693 for an applicant and seals the envelope. Two weeks later, the applicant returns saying they found a new vaccination record proving they already received a required vaccine. The civil surgeon opens the sealed envelope to add the record. Is this acceptable?
- Yes, the civil surgeon may open and update the sealed I-693 at any time before submission to USCIS
- No, once the I-693 is sealed it cannot be re-opened; the civil surgeon must complete a new I-693 examination (Correct answer)
- Yes, but the civil surgeon must add a cover letter to USCIS explaining the addition
- No, the applicant should submit the vaccination record separately directly to USCIS with a written explanation
Correct answer: No, once the I-693 is sealed it cannot be re-opened; the civil surgeon must complete a new I-693 examination
USCIS policy requires the I-693 to remain sealed once the civil surgeon has completed and signed it; opening the envelope invalidates the form and a new exam is required.
Question 2: An applicant with a prior DUI conviction 8 years ago is being examined by a civil surgeon. The applicant reports no current alcohol use and has completed all court-ordered treatment. How should the civil surgeon classify this finding for the I-693?
- Class A because any substance-related legal history is permanently inadmissible
- Evaluate for current alcohol use disorder; if no current disorder is present and the past event is isolated, it may not warrant a Class A or Class B designation (Correct answer)
- Class B automatically for any history of substance-related offense regardless of current status
- Refer to USCIS to make the admissibility determination; civil surgeons do not assess alcohol history
Correct answer: Evaluate for current alcohol use disorder; if no current disorder is present and the past event is isolated, it may not warrant a Class A or Class B designation
The civil surgeon's role is to assess current medical conditions; a single past DUI with no current disorder and completed treatment would not necessarily result in a Class A or B medical finding.
Question 3: A civil surgeon is asked to examine a 3-month-old infant applying for a green card. The infant cannot yet receive several age-inappropriate vaccines on the required schedule. How should this be handled?
- Defer the entire I-693 until the infant reaches age 2 and all vaccines can be administered
- Document age-inappropriate vaccines as not yet due and administer those appropriate for the infant's age; USCIS allows for age-based deferrals (Correct answer)
- Mark all missing vaccines as 'refused' and advise the parents to file individual vaccine waivers
- Classify the infant as temporarily inadmissible until the full vaccination schedule is complete
Correct answer: Document age-inappropriate vaccines as not yet due and administer those appropriate for the infant's age; USCIS allows for age-based deferrals
Age-appropriate vaccine scheduling applies to infants; the civil surgeon administers vaccines that are due for the infant's age and documents others as age-deferred.
Question 4: An applicant's I-693 is rejected by USCIS because the civil surgeon's name stamp and signature are missing from one page. The applicant returns to the civil surgeon's office, but the original civil surgeon has retired. What is the correct resolution?
- The civil surgeon's former partner may sign the page on their behalf
- The applicant must undergo a complete new I-693 examination with a currently designated civil surgeon (Correct answer)
- The applicant may submit a signed affidavit from the retired civil surgeon by mail
- USCIS will accept the form with a notarized statement explaining the missing signature
Correct answer: The applicant must undergo a complete new I-693 examination with a currently designated civil surgeon
A new I-693 examination with a currently designated civil surgeon is required when the original cannot be corrected by the original examining physician.
Question 5: During an I-693 exam, a civil surgeon discovers an applicant has active pulmonary tuberculosis confirmed by sputum culture. The applicant is unaware of the diagnosis. What are the civil surgeon's obligations?
- Complete the I-693 with a Class A finding and mail it to USCIS; patient notification is optional
- Inform the applicant of the diagnosis, refer for treatment, report to the local health department per mandatory reporting laws, and classify as Class A on the I-693 (Correct answer)
- Notify USCIS first, then inform the applicant after receiving instructions from USCIS
- Withhold the diagnosis until USCIS makes a final admissibility determination to avoid alarming the applicant
Correct answer: Inform the applicant of the diagnosis, refer for treatment, report to the local health department per mandatory reporting laws, and classify as Class A on the I-693
Civil surgeons are bound by medical ethics and law to inform patients of diagnoses, report active TB to public health authorities, and classify the condition as Class A on the I-693.
Question 6: An applicant files for adjustment of status and submits an I-693. USCIS sends an RFE stating that the civil surgeon who signed the form was not designated at the time of the exam. The applicant argues the civil surgeon's name appears on the USCIS website. What likely explains the discrepancy?
- USCIS made an administrative error; website listing is proof of active designation
- The civil surgeon's designation may have been inactive at the exam date but reinstated before the USCIS website was updated, or the exam occurred during a lapse between designations (Correct answer)
- The USCIS website does not reflect real-time designation status; applicants cannot rely on it to confirm designation
- The civil surgeon was listed as 'pending' rather than 'active' on the date of the exam
Correct answer: The civil surgeon's designation may have been inactive at the exam date but reinstated before the USCIS website was updated, or the exam occurred during a lapse between designations
USCIS designations can lapse and be reinstated; a civil surgeon currently listed may have had a gap in designation, and the exam date may fall within that gap.
Question 7: A civil surgeon is completing an I-693 for a 70-year-old applicant. The applicant's physician has provided a letter stating the pneumococcal polysaccharide vaccine (PPSV23) is contraindicated due to a documented adverse reaction. The applicant has never received it. How should the civil surgeon proceed?
- Override the personal physician's recommendation and administer PPSV23 because it is required for all adults over 65
- Document the contraindication on the I-693 based on the treating physician's letter and do not administer the vaccine (Correct answer)
- Administer the alternative pneumococcal conjugate vaccine (PCV15) instead and note it as a substitution
- Require the applicant to obtain a second opinion from an infectious disease specialist before accepting the contraindication
Correct answer: Document the contraindication on the I-693 based on the treating physician's letter and do not administer the vaccine
A contraindication documented by a treating physician is a valid basis for exemption; the civil surgeon records it on the I-693 rather than administering a contraindicated vaccine.
USCIS Case Studies & Practical Application 5
A civil surgeon completes an I-693 for an applicant and seals the envelope.
Two weeks later, the applicant returns saying they found a new vaccination record proving they already received a required vaccine.
The civil surgeon opens the sealed envelope to add the record.
Is this acceptable?