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(7) Aliens not comprehended within any of the foregoing classes who are certified by the examining surgeon as having a physical defect, disease, or disability, when determined by the consular or immigration officer to be of such a nature that it may affect the ability of the alien to earn a living, unless the alien affirmatively establishes that he will not have to earn a living.

Section 221 (d) of the same act states:

Prior to the issuance of an immigrant visa to any alien, the consular officer shall require such alien to submit to a physical and mental examination in accordance with such regulations as may be prescribed. Prior to the issuance of a nonimmigrant visa to any alien, the consular officer may require such alien to submit to a physical or mental examination, or both, if in his opinion such examination is necessary to ascertain whether such alien is eligible to receive a visa.

Regulations of the Department of State require each applicant for an immigrant visa to undergo a physical and mental examination by a medical officer of the United States Public Health Service, or, at consulates where such an officer is not available, by a physician selected by the alien from a panel approved by the consular officer. The same regulations require an applicant for a nonimmigrant visa to undergo such an examination if he is coming from an area or in a status which indicates that a medical examination is advisable, or if the consular officer otherwise has reason to believe the examination would disclose that the alien is ineligible to receive a visa. Admissibility to the United States is not assured for aliens who have been found free from excludable conditions at consulates, since an alien to whom a visa has been issued is not entitled to enter the United States if he is found, upon arrival, to be inadmissible under the Immigration and Nationality Act.

Section 234 of the Immigration and Nationality Act states:


The physical and mental examination of arriving aliens (including alien crewmen) shall be made by medical officers of the United States Public Health Service, who shall conduct all medical examinations and shall certify, for the information of the immigration officers and the special inquiry officers, any physical an defect or disease observed by such medical officers in alien. If medical officers of the United States Public Healt! are not available, civil surgeons of not less than 4 sional experience may be employed for such terms as may be prescribed by the Attorney Gens ing alien crewmen) arriving at ports of the examined by at least one such medical office

such administrative regulations as the Attorney General may prescribe, and under medical regulations prepared by the Surgeon General of the United States Public Health Service. Medical officers of the United States Public Health Service who have had special training in the diagnosis of insanity and mental defects shall be detailed for duty or employed at such ports of entry as the Attorney General may designate, and such medical officers shall be provided with suitable facilities for the detention and examination of all arriving aliens who it is suspected may be excludable under paragraphs (1), (2), (3), (4), or (5) of section 212 (a), and the services of interpreters shall be provided for such examination. Any alien certified under paragraphs (1), (2), (3), (4), or (5) of section 212 (a) may appeal to a board of medical officers of the United States Public Health Service, which shall be convened by the Surgeon General of the United States Public Health Service, and any such alien may introduce before such board one expert medical witness at his own cost and expense.

It is important for examiners to bear in mind that the medical examination of aliens constitutes a step in a legal procedure having for its purpose the determination of whether an alien is admissible to the United States. This decision is made by the consular and immigration authorities. However, the report of the results of the medical examination, made as required by law, constitutes a part of the official record of the legal procedure. That procedure may include a review by: an officer in charge of a port or district; a special inquiry officer; a Regional Commissioner; an Assistant Commissioner or the Commissioner; the Board of Immigration Appeals; the Attorney General; and the courts. The conduct of the medical examination and the manner of reporting the results therefore must be in accord with the provisions he immigration law and of the medical regulations issued by

vice. Conclusions reported should be based on demonstra ical n accordance with standard medical practice. It is of

to perform medical examinations that со

establish whether or not the alien falls lec

excludable under the immigration law. In

ion the physician depends to a large excal history of the individual. This may be nigration work, because the alien and his be loath to admit the existence of any abimit the completeness and effectiveness

must be compensated for as far as and the diligent investigation of any ncover.


Diseases and defects in aliens are grouped into three classes-A, B, and C--as a simple means of indicating the significance of diagnosed conditions with respect to the Immigration and Nationality Act. The act provides that certain diseases and defects are excludable from the United States (sec. 212 (a), (1)-(6), quoted above). These conditions are grouped in class A by the regulations. In general terms they are the mental diseases and defects and certain serious communicable diseases.

The act provides that other physical conditions may be excluded, depending on their liability to affect an alien's earning capacity and to cause him to become a public charge (sec. 212 (a) (7), above). Consular and immigration officers make all decisions with regard to the excludability of these conditions, taking into account the relevant social and economic factors. These conditions are designated as class B. Since the medical examiner does not make the determination regarding the effect on an alien's ability to earn a living, the regulations simply group in class B all physical conditions serious in degree or permanent in nature amounting to a substantial departure from normal physical well-being. Although class B conditions are not mandatorily excludable, any severe or even fatal disease not specified in the regulations as class A is included in class B--for example, incurable cancer. From the immigration standpoint a person with this disease would be purely a socioeconomic problem. If he has assurances that he will not become a public charge (and this is determined by consular and immigration officials), he may be admitted.

Class C includes minor diseases and defects not amounting to a substantial departure from normal well-being and not affecting an alien's admissibility. They are reported as a matter of record, and in order that appraisals can be made of the correctness of the medical examination work.

Examinations must be impartially performed; examiners shall not be influenced by any consequence of enforcement of the law and regulations.

Physicians and inspectors shall carefully check identification data in documents or other materials presented by aliens who are examined or inspected, to detect any attempted substitution of persons or papers.

In the discharge of their duties, officers come in contact with foreign persons who are of varying social attainments and who often speak only a foreign language. Officers should, of course, by their appearnce and conduct maintain the dignity of their Government. This implies neatness in personal appearance; tact; courteous firmness in deportment; and consideration of the feelings of others.

Comments on this manual are invited, and should be addressed


U.S. Department of Health, Education, and Welfare
Public Health Service
4th and Independence Avenue S.W.
Washington 25, D.C.

Attention: Chief Division of Foreign Quarantine

May 23, 1963

James S. Felpe

James G. Telfer, Medical Director,

Chief, Division of Foreign Quarantine.

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