Preface

This supersedes the Manual for Medical Examination of Aliens dated March 22, 1956, and its amendments.

A copy is to be provided to each medical officer and quarantine inspector concerned. Arrangements have been made for consular officers to receive copies for distribution to panel physicians examining visa applicants where Public Health Service officers are not assigned.

This edition consolidates provisions of the preceding edition and its amendments, for convenience. Some changes have been made in those provisions, including changes in sections on the venereal diseases. As soon as feasible, a revised edition will be published containing further changes in medical provisions.

(Loose-leaf binders of the earlier editions should be retained for possible future use.)

May 23, 1963

Introduction

This manual is for the guidance of medical officers of the Public Health Service and others concerned with examining aliens either in foreign countries or in the continental United States, its territories, and its possessions. It is not a medical textbook;1 it is intended to serve as a source of information on special procedures involved in interpreting and administering the Regulations for the Medical Examination of Aliens as promulgated by the Surgeon General of the United States Public Health Service and approved by the Secretary of Health, Education, and Welfare. Persons using this manual should be thoroughly familiar with those regulations, which are reproduced in chapter 1 for convenient reference.

The law under authority of which the examinations are conducted includes the Public Health Service Act and the Immigration and Nationality Act of 1952, as amended.

Section 325 of the Public Health Service Act states:

The Surgeon General shall provide for making, at places within the United States or in other countries, such physical and mental examinations of aliens as are required by the immigration laws, subject to administrative regulations prescribed by the Attorney General and medical regulations prescribed by the Surgeon General with the approval of the Secretary.

Section 212 (a) of the Immigration and Nationality Act, as amended, states:

Except as otherwise provided in this Act, the following classes of aliens shall be ineligible to receive visas and shall be excluded from admission into the United States:

(1) Aliens who are feeble-minded;

(2) Aliens who are insane;

(3) Aliens who have had one or more attacks of insanity;

(4) Aliens afflicted with psychopathic personality, epilepsy, or a mental defect;

(5) Aliens who are narcotic drug addicts or chronic alcoholics; (6) Aliens who are afflicted with any dangerous contagious disease;

1 Since in the conduct of their work examiners are likely to encounter exotic diseases, they should consult approved textbooks in order to be thoroughly familiar with the manifestations of such diseases.

(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 and mental defect or disease observed by such medical officers in any such alien. If medical officers of the United States Public Health Service are not available, civil surgeons of not less than 4 years' professional experience may be employed for such service upon such terms as may be prescribed by the Attorney General. Aliens (including alien crewmen) arriving at ports of the United States shall be examined by at least one such medical officer or civil surgeon under

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 of the immigration law and of the medical regulations issued by the Service. Conclusions reported should be based on demonstrable medical facts in accordance with standard medical practice.

It is the duty of examiners to perform medical examinations that are sufficiently complete to establish whether or not the alien falls within one of the categories excludable under the immigration law. In the usual medical examination the physician depends to a large extent on an accurate medical history of the individual. This may be difficult to obtain in immigration work, because the alien and his family and friends may be loath to admit the existence of any abnormality. This will tend to limit the completeness and effectiveness of a medical examination and must be compensated for as far as possible by astute observations and the diligent investigation of any leads which the examiner may uncover.