§34.11 Deferral of examination; adequacy of facilities.

(a) Whenever, upon an examination, it appears to the medical officer in charge that there is doubt about the physical or mental condition of an alien, completion of the examination shall be deferred for such observation and further examination of the alien as may be reasonably necessary to determine his physical or mental condition.

(b) When, in the judgment of the Medical Officer in Charge, a medical examination in the United States or in a territory or possession thereof cannot be satisfactorily completed at a station or place at which it is undertaken, such examination shall be discontinued and such officer shall request of the Immigration Service that the alien be removed to a place where the examination may be satisfactorily completed.

$34.12 Applicability of Foreign Quarantine Regulations. Aliens arriving at a port of the United States shall be subject to the applicable provisions of Part 71 of this chapter (Foreign Quarantine Regulations of the Public Health Service) with respect to examination and sanitary and quarantine measures.

§34.13 Medical and other care; death.

(a) Upon request by the Immigration Service, an alien detained by it shall be admitted to a hospital or station of the Public Health Service and receive therein necessary medical, surgical, and dental care. An alien found to be in need of emergency care in the course of an examination or reexamination in the United States, or in a territory or possession thereof, shall be given such care to the extent deemed practicable by the Medical Officer in Charge, and if in need of further care he shall be referred to the immigration authority concerned, with the medical examiner's recommendations concerning such further care.

(b) In case of death of an alien the body shall be delivered to the consular or immigration authority concerned; but if such death occurs in the United States, or in a territory or possession thereof, public burial shall be provided upon request of the Immigration Service and subject to its agreement to pay the burial expenses. Autopsies shall not be performed unless approved by the Immigration Service.

$34.14 Reexamination; convening of boards; expert witnesses; reports.

(a) The Surgeon General or, when authorized, the Medical Officer in Charge, shall convene a board of medical officers to reexamine an alien:

(1) Upon the request of the Immigration Service for a reexamination by such a board, or

(2) Upon an appeal by an alien who, having received a medical examination in connection with determination of admissibility to the United States (including examination on arrival, adjustment of status, and preexamination as provided in the immigration laws and regulations) has been certified for: feeble-mindedness; insanity; one or more previous attacks of insanity; psychopathic personality; epilepsy; mental defect; narcotic drug addiction; or chronic alcoholism.

(b) Such a board shall consist of three, when practicable, but in no case less than two, medical officers. If a board of two officers is unable to reach agreement, a new board shall be convened and shall reexamine the alien. In the event that a board consists of three medical officers, the decision of the majority thereof shall prevail.

(c) Reexamination shall include:

(1) A medical examination by the board. If the mental condition of the alien is in question and the board does not include at least one officer who has had special training in the diagnosis of mental defects, diseases, and disabilities, the board shall designate a physician with such training who shall also examine the alien, and his report shall be included in the record.

(2) A review of all records submitted by the alien, other witnesses, or the board.

(3) Use of any laboratory or diagnostic methods or tests deemed advisable.

(4) Consideration of statements regarding the alien's physical or mental condition made by a physician after his examination of the alien.

(d) An alien who is to be reexamined shall be notified of the time and place of his reexamination not less than five days prior thereto.

(e) The alien may introduce as witnesses before the board such physicians or medical experts as the board may in its discretion permit, at his own cost and expense: Provided, That the alien shall be permitted to introduce at least one expert medical witness. If any witnesses offered are not permitted by the board to testify, the record of the proceedings shall show the reason for the denial of permission.

(f) Witnesses before the board shall be given a reasonable opportunity to examine medical certificates and other records involved in the reexamination and to present all relevant and material evidence orally or in writing until such time as the proceedings are declared by the board to be closed. During the course of the hearing the alien's attorney or representative shall be permitted to examine

the alien and he, or the alien, shall be permitted to examine any witnesses offered in the alien's behalf and to cross-examine any witnesses called by the board. If the alien does not have an attorney or representative, the board shall assist the alien in the presentation of his case to the end that all of the material and relevant facts may be adduced.

(g) The findings and conclusions of the board shall be based on its medical examination of the alien and on the evidence presented and made a part of the record of its proceedings.

(h) The board shall report its findings and conclusions to the Immigration Service, and shall also give prompt notice thereof to the alien if the reexamination has been held upon his appeal. The board's report to the Immigration Service shall specifically affirm, modify, or reject the findings and conclusions of prior examining medical officers.

(i) If the board finds that an alien reexamined by it has a defect, disease, or disability, or has had one or more attacks of insanity, not previously certified, it shall issue its certificate in accordance with the applicable provisions of this part.

(j) After submission of its report the board shall not be reconvened, nor shall a new board be convened, in connection with the same application for admission or for adjustment of status, except upon the express authorization of the Surgeon General.

Validity period of immigrant medical examinations
Procedure.

Special information in medical reports. .

Deferred examination

Special facilities for examination

Reexamination.

2-1

2-8

2-8

2-9

2-10

Adjustment of status cases--United States only
Medical examination of visa applicants who are in the

2-10

Custody and transfer of aliens--United States

Acute communicable disease

2-18

Promptness.

Record of examinations.

2-19

2-19

General

1. At consular offices.-- Aliens shall be given a medical examination when referred by the consular authority.

2. In the United States, its territories, and possessions.1

a. The medical examination of arriving aliens routinely shall consist of a medical inspection, as explained in chapter 3. Further examination shall be made when the medical inspection suggests the possible presence of a class A condition (a condition which ordinarily renders the alien ineligible for admission) or a class B condition (a significant physical defect, disease, or disability other than class A).

b. Aliens presently in the United States are given a medical examination when referred by the Immigration Service.

c. The Division of Foreign Quarantine is basically responsible for the conduct of medical examinations of aliens in accordance with

1 Throughout this manual, procedures specified for United States ports are also applicable at stations in other countries where persons to whom visas have been issued are examined in connection with determination of admissibility to the United States, with findings reported to the Immigration Service.

the regulations. Where there is a Public Health Service Hospital or Clinic in the area of a quarantine station, and under a separate Medical Officer in Charge, the quarantine MOC should collaborate with the former to ensure that the requirements of the regulations and this manual are observed with regard to examinations performed at the hospital or clinic. He should make certain it reports the results of all examinations properly to the Immigration Service, and also notifies the quarantine station of results when aliens are examined after issuance of a medical hold. In these cases the hospital or clinic should send the quarantine station a copy of the medical certificate reporting the presence of a defect, disease, or disability, or a copy of the report of negative findings. See Appendix B. (See special procedure in adjustment of status cases, par. 41, this chapter.)

3. Refusal to be examined.-- When an alien refuses to submit to medical examination, the physician shall neither examine him nor pass upon the validity of any claim to exemption, but shall refer him to the consular or immigration authority concerned, with a written statement of the reason no examination was made.

Validity Period of Immigrant Medical
Examinations

4. General.

a. Basic Rules. Medical examinations conducted in connection with immigrant visa applications may be considered to have a maximum validity of six months. The chest X-ray film for the purpose of this medical examination routinely has validity of one additional month to allow time for the film and any necessary report of radiological interpretation to reach the medical examiner. The schedule of chest X-ray, medical examination, and visa issuance may be adjusted as to interval as long as the date on the X-ray film will be no longer than seven months and the date on medical examination from FS-398 no longer than six months before the date that the alien will enter the United States.

b. Exceptions--X-ray Films.

(1) Where an official United States Public Health Service consultation is obtained, the date of this consultation may be placed on medical examination form FS-398 as the determining date for validity, and the Public Health Service consultant's signature will establish validity of the X-ray film. To allow time for the consultation procedure, the date on the X-ray film may be as much as three months before the date on form FS-398 and nine months before the date of entry into the United States.