USCIS Risk Assessment & Management 4 — Questions and Answers
Question 1: A civil surgeon examines an applicant who discloses a history of inpatient psychiatric hospitalization 10 years ago for a single depressive episode, now fully recovered. What is the appropriate risk classification?
- Class A — any psychiatric hospitalization is automatically inadmissible
- Class B — physical or mental abnormality, disease, or disability (Correct answer)
- No notation — the episode is resolved and too remote to document
- Immediate referral to a psychiatrist before completing the exam
Correct answer: Class B — physical or mental abnormality, disease, or disability
A past psychiatric condition that is resolved and not associated with harmful behavior is a Class B notation; it does not meet the Class A threshold for mental health inadmissibility.
Question 2: Which of the following best describes the civil surgeon's risk management obligation when an applicant's vaccination records are unavailable?
- Waive all vaccine requirements and note 'records unavailable' on Form I-693
- Administer age-appropriate vaccines or obtain serologic evidence of immunity (Correct answer)
- Defer the exam until the applicant retrieves records from their home country
- Accept self-reported vaccination history without documentation
Correct answer: Administer age-appropriate vaccines or obtain serologic evidence of immunity
When records are unavailable, the civil surgeon must either administer required vaccines or obtain serologic confirmation of immunity; self-report alone is insufficient.
Question 3: An applicant is found to have active pulmonary TB. What is the correct sequence of risk management steps before Form I-693 can be completed?
- Complete the form immediately with a Class A notation and let USCIS decide next steps
- Refer for directly observed therapy (DOT), confirm treatment response, then complete the form (Correct answer)
- Refer to a health department and wait 6 months before scheduling a follow-up exam
- Administer empirical isoniazid and complete the form after 2 weeks
Correct answer: Refer for directly observed therapy (DOT), confirm treatment response, then complete the form
Active TB must be treated under a supervised regimen until the applicant is no longer infectious and clinically responding before the civil surgeon can complete Form I-693.
Question 4: An applicant applying for adjustment of status is 45 years old. Which vaccines are required as part of the USCIS medical examination for this age group?
- Only childhood vaccines — MMR, varicella, and polio
- All ACIP-recommended vaccines for the applicant's age, including influenza and Td/Tdap (Correct answer)
- Only vaccines for communicable diseases listed by CDC as quarantinable
- Only vaccines the applicant has never received, regardless of ACIP schedule
Correct answer: All ACIP-recommended vaccines for the applicant's age, including influenza and Td/Tdap
USCIS requires all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) for the applicant's age and medical history, including adult vaccines like influenza and Td/Tdap.
Question 5: A civil surgeon identifies an applicant who appears intoxicated during the physical examination. What is the most appropriate risk management response?
- Complete the exam and note suspected alcohol use as a Class B finding
- Reschedule the exam and document the presentation; assess for alcohol use disorder at the next visit (Correct answer)
- Call USCIS immediately and report the applicant
- Administer a breathalyzer test and note the result on Form I-693
Correct answer: Reschedule the exam and document the presentation; assess for alcohol use disorder at the next visit
Conducting an accurate exam on an intoxicated applicant is not feasible; rescheduling and assessing for alcohol use disorder at a follow-up visit is the appropriate professional response.
Question 6: Under the USCIS Technical Instructions, how should a civil surgeon handle a syphilis screening result that is reactive on an RPR but non-reactive on a confirmatory treponemal test?
- Treat for syphilis and document as Class A
- Classify as a biologic false positive and document as not infectious for syphilis (Correct answer)
- Refer to an infectious disease specialist immediately
- Repeat both tests in 30 days before making any classification
Correct answer: Classify as a biologic false positive and document as not infectious for syphilis
A reactive non-treponemal test (RPR) with a non-reactive confirmatory treponemal test (e.g., FTA-ABS) is a biologic false positive; the applicant is not classified as having syphilis.
Question 7: What form must a civil surgeon use to document findings and communicate the medical risk assessment to USCIS for adjustment of status applicants?
- Form I-485
- Form I-693 (Correct answer)
- Form DS-2053
- Form I-864
Correct answer: Form I-693
Form I-693 (Report of Medical Examination and Vaccination Record) is the official document civil surgeons complete for USCIS adjustment of status medical evaluations.
USCIS Risk Assessment & Management 4
A civil surgeon examines an applicant who discloses a history of inpatient psychiatric hospitalization 10 years ago for a single depressive episode, now fully recovered.
What is the appropriate risk classification?