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  1. Introduction These Questions and Answers provide basic information about the general vaccination requirements for immigrants (including individuals seeking adjustment of status), and specifically about the assessment made by the civil surgeon to determine whether an applicant meets the vaccination requirements. These Questions and Answers do not address the vaccination assessments conducted by panel physicians overseas. For refugees only, health departments may be considered a civil surgeon for purposes of completing the vaccination record. Related Forms --o USCIS Form I-693, Report of Medical Examination and Vaccination Record Background Under the immigration laws of the United States, a foreign national who applies for an immigrant visa abroad, or who seeks to adjust status to a permanent resident while in the United States, is required to receive vaccinations to prevent the following diseases: --o Mumps --o Measles --o Rubella --o Polio --o Tetanus and Diphtheria Toxoids --o Pertussis --o Haemophilus influenzae type B --o Hepatitis B --o Any other vaccine-preventable diseases recommended by the Advisory Committee for Immunization Practices The Advisory Committee for Immunization Practices (ACIP) is an advisory committee to the Department of Health and Human Services (HHS)/Centers for Disease Control and Prevention (CDC) that recommends immunizations for the general U.S. population. Starting Dec.14, 2009, when the ACIP recommends new vaccines for the general U.S. population, CDC will assess whether these vaccines should be required for immigration purposes on a regular and on an as-needed basis according to specific criteria set by CDC. CDC is responsible for publishing the Technical Instructions for the Medical Examination of Aliens in the United States. These documents set the requirements for the immigrant medical examination and are binding on civil surgeons. The Technical Instructions include a vaccination component, specifying how the civil surgeon has to conduct the vaccination assessment. The civil surgeon records the results of the medical examination, including the results of the vaccination assessment, on USCIS Form I-693, Report of Medical Examination and Vaccination Record. If a foreign national applies for an immigrant visa abroad, that individual has to receive the medical examination by a panel physician designated by the U.S. Department of State (DOS). CDC issues separate instructions to panel physicians designated by DOS to conduct medical examinations abroad. For more information about panel physicians, please consult DOS' website at https://travel.state.gov/visa/immigrants/info/info_3739.html. Questions and Answers Q. Where can I find information about vaccinations in general? A. CDC publishes information about vaccinations in general and information about the vaccine requirements for immigration purposes at https://www.cdc.gov/vaccines/. Q. Why do immigrants and adjustment of status applicants have to show proof they have received certain vaccinations? A. In 1996, Congress provided in legislation that every immigrant entering the United States, or every individual seeking adjustment of status to that of a legal permanent resident, show proof that he or she was vaccinated against vaccine-preventable diseases. The text for this requirement is in the Immigration and Nationality Act (INA), section 212(a)(1)(A)(ii). Q. How does the CDC decide which vaccines are required for immigration purposes? A. Some of the vaccines that are required are specifically listed in the INA. In addition to these, the statute also requires that an individual receive any other vaccinations recommended by the ACIP. CDC uses the following criteria in determining which of these recommended vaccines should be required for immigration purposes: --o The vaccine must be an age-appropriate vaccine as recommended by the ACIP for the general U.S. population, and --o At least one of the following: --o The vaccine must protect against a disease that has the potential to cause an outbreak; or --o The vaccine must protect against a disease eliminated in the United States, or is in the process of being eliminated in the United States. Q. I am seeking immigrant status in the United States but had a medical examination abroad by a panel physician; I also received some vaccines. Do I have to repeat the medical examination and get the vaccines again? A. Please read the instructions to Form I-693 to determine if you must repeat the medical examination, including the vaccination assessment, based on your current status in the United States. Q. How do I know which vaccines are required for immigration purposes? A. A civil surgeon is required to follow the Technical Instructions for the Examination of Aliens in the United States, including the 2009 Technical Instructions to Civil Surgeons for Vaccinations, and any updates published online. CDC publishes the vaccination requirements and medical examination instructions (including a detailed table listing all required vaccines) at cdc.gov Q. Do I have to receive all the required vaccines, even though I have been vaccinated before? A. No. The civil surgeon will review your vaccination records at the time of your medical examination to see whether you have proof of earlier vaccinations against vaccine-preventable diseases that are appropriate for your age category. It is important that you take any written vaccination documentation you may have to the civil surgeon when you have your immigration medical examination. If you lack any vaccinations required for your age category, the civil surgeon will administer the vaccines as needed. In the alternative, you can also choose to obtain the required vaccines from your private healthcare provider. However, because only a civil surgeon is authorized to complete the vaccination assessment on the Form I-693, you must return to the civil surgeon with the proof that you have received the missing vaccines. In addition, some individuals are immune to vaccine-preventable diseases, and they know of the immunity because their private healthcare provider has tested them. If you have any written evidence of immunity, you should take this documentation to your civil surgeon. This will enable the civil surgeon to determine which vaccines you need to receive. Q. Do I have to receive all the vaccines on CDC's vaccination list for the immigrant population, or only the ones that are age appropriate? A. You are required to document receipt of vaccines that are age appropriate for you. The civil surgeon will annotate Form I-693 to indicate that you were not required to receive a particular vaccine because it was not age appropriate at the time of the medical examination. Q. Do I have to receive all the vaccines that are on CDC's list and that are age appropriate, although I may have a medical condition that prevents me from receiving the required vaccines? A. If you have a medical condition that prevents you from receiving a vaccine that is appropriate for your age, the civil surgeon will annotate the Form I-693 accordingly and mark the vaccine as contraindicated. A contraindication is a condition that prevents you from receiving a particular vaccine. CDC lists in its Technical Instructions what is considered a contraindication. It is up to the civil surgeon to determine whether you have such a condition that prevents you from receiving a particular vaccine at the time of the immigration medical examination. Q. Certain vaccine series can only be completed with multiple visits to the civil surgeon. Am I required to complete the entire series before the civil surgeon can sign the Form I-693? A. You are only required to receive a single dose of each vaccine when you visit the civil surgeon. You are encouraged to follow up with your private health care provider to complete the series. Once you have received the single dose appropriate at the time, the civil surgeon can sign and certify the Form I-693. Q. I am pregnant and do not wish to receive any vaccinations. Do I still have to get them to be able to obtain permanent resident status in the United States? A. If you are pregnant, the CDC's Technical Instructions direct the civil surgeon how to evaluate the vaccines you are able to receive during pregnancy. If the civil surgeon cannot safely administer a required vaccine, he/she will annotate the Form I-693 by marking the vaccine as contraindicated. See link to the right for information on pregnancy and vaccinations in general. Q. Can the civil surgeon safely administer all vaccines that are required all at once? A. The civil surgeon will let you know if you can receive all the vaccines at once, or if there is a concern based on your particular medical condition that will not allow you to receive all required vaccines at once. Q. When does the flu season start for purposes of the seasonal flu vaccine requirement? Since the seasonal flu vaccine is required, do I have to get the seasonal flu vaccine if it is not the flu season? A. For purposes of the immigration medical examination, the flu season starts on October 1 and ends on March 31 each year. If your immigration medical examination is during this period, you are required to have the seasonal flu vaccine. If you have an immigration medical examination completed between April 1 and September 30, when it is not the flu season for immigration purposes, you are not required to document that you have received the seasonal flu vaccine. Q. I heard that the vaccine against herpes zoster (zoster) and the Human Papillomavirus (HPV) are required vaccines. Is this true? A. From Aug. 1, 2008, until Dec. 13, 2009, the zoster and the HPV were required vaccines for immigration purposes. However, the zoster vaccine was not available from Aug. 1, 2008, through Dec. 13, 2009, and USCIS posted a message on the Web to inform civil surgeons they could annotate the vaccination record with "not available" if they were not able to obtain the vaccine. In 2009, CDC changed the vaccination requirements based on ACIP's recommendations. As of Dec. 14, 2009, the zoster and the HPV vaccine were no longer required. Q. I had my immigration medical examination before Dec. 14, 2009, before the zoster and HPV vaccines were eliminated. I was required to have one of them, but did not receive it. My Form I-693 says that I refused to have the HPV or zoster vaccine. Will my I-693 be returned or my application denied? A. On Dec. 14, 2009, vaccines against herpes zoster (zoster) and HPV are no longer required. It is irrelevant that you did not receive either the zoster or the HPV because beginning on Dec. 14, 2009; you are no longer inadmissible solely because you did not have the vaccine. USCIS will not return your Form I-693, nor will it deny your application because you did not receive the vaccine. Q. Who pays for the vaccinations? A. The applicant is responsible for paying the appropriate fee for all vaccinations directly to the civil surgeon, as agreed upon with the civil surgeon. You should ask about the price of the vaccinations before the medical examination or the administration of the vaccinations. Q. Can I be forced to be vaccinated for immigration purposes? A. If you refuse to receive the vaccines required for immigration purposes, as mandated by the immigration laws of the United States, your application for legal permanent resident status may be denied. Q. What will happen if I refuse to receive one or all of the required vaccines? A. Tell the civil surgeon if you do not wish to receive the required vaccines or a particular vaccine. You should also tell the civil surgeon the reason you do not wish to receive the vaccine(s). In this case, a waiver may be available to you, but only under the following circumstances: --o You are opposed to vaccinations in any form– that is, you cannot obtain a waiver based on an objection only as to one vaccination --o Your objection must be based on religious beliefs or moral convictions; and --o The religious or moral beliefs must be sincere. The form used to apply for a waiver depends on the adjustment category under which you are seeking legal permanent residence status. For example, refugees and asylees seeking adjustment of status should file Form I-602, Application by Refugee for Waiver of Grounds of Excludability. Individuals seeking adjustment of status as a result of an approved Form I-130, Petition for Alien Relative, or Form I-140, Immigrant Petition for Alien Worker, would file Form I-601, Application for Waiver of Grounds of Inadmissibility. Q. My civil surgeon says that a vaccine is currently not available. What should I do? A. Ask the civil surgeon whether another health care provider may have the vaccine. If another physician or department or pharmacy carries the vaccine and can administer the vaccine, you should get the vaccine and request documentation that you have received the vaccine. Bring the written record back to the civil surgeon so that s/he can complete the Form I-693. HHS/CDC monitors which vaccines are not available in the United States, or which vaccines may experience a shortage. If CDC determines there is a nation-wide shortage of a vaccine, it will recommend to USCIS to post a message on www.uscis.gov to explain to applicants and civil surgeons whether the vaccine is required and under what circumstances. The information is available on USCIS’ Form I-693 page, the Immigration Medical Examination page, or the Designated Civil Surgeon page. Q. Will USCIS accept a Form I-693 if the vaccination chart is incomplete? A. No. The vaccination chart should have at least one entry in each row for each vaccine. If the vaccination chart is not properly completed at the time of the medical examination, USCIS may return the Form I-693 to you with instructions on how to correct it. If you refuse a vaccine because of religious or moral reasons, the civil surgeon will mark this on the Form I-693. In this case, you will have to apply for a waiver. Q: Where can I find more information about the vaccination requirements for immigration purposes and how these requirements affect the completion of Form I-693? A. CDC publishes the Technical Instructions including the vaccination component cdc.gov For more information about the civil surgeon program, the completion of Form I-693, or the adjustment of status application, please visit www.uscis.gov, or call USCIS’ National Customer Service Center at 1-800-375-5283 (TTY 1-800-767-1833).
  2. Hi guys, I was missing few vaccinations during medical exam for K-1 visa. Doctors adviced me to get missing vaccinations done in UK, before I leave the country. This is so I don't need to pay for doctors in US. I got all done with my surgeon in UK and have proofs with me. Now preparing docs for AOS. After reading the medical form I-693 requirements, I got confused if I need to see civil surgeon again? Or is it enough to send copies as an attachment with my application?
  3. In DS-260 there is a question like Do you have documentation to establish that you have received vaccinations in accordance with U.S. law? What should I write to this question? Yes or No? I know I have received vaccines since my birth which were managed by my parents but there is no record or documentations to prove it.
  4. Hi all, Could somebody offer me some information on a issue I am having. I completed my Medical Exam in Feb 2018. At the time of the exam I was missing 2 vaccinations. The nurse who was conducting my exam told me I could quite easily get the vaccinations after I enter the US. I wish I had got them done at the time of the medical because it seems incredibly confusing as to the steps I should take now. I have recently received my interview date for green card (june 17th). So now I must get the outstanding vaccinations. Getting the vaccinations isn't a problem but I am confused on the steps I should take after getting my vaccinations. I have read that I will need to visit a civil surgeon to get them to transcribe onto I-693. After looking at form I-693 it seems it asks the doctor to provide all the findings of my medical exam. Obviously I don't want another exam but don't have the details of my previous exam in London. All i have is my vaccination record completed by the doctor at my medical which is missing the 2 outstanding vaccinations. I know not all doctors will transcribe vaccinations and will want to do an entire new medical. I'm sure I can find a doctor that will transcribe but i am clueless on what I will need to provide them or If i have the required information for them. Can anyone advise me on what best I should do? Thanks in advance
  5. Hello, I was reviewing my AOS packet and while giving a second read to the I-693 instructions something caught my attention. I did my medical in March 2018 and I received a completed Form DS-3025 to include in the application. My vaccinations record show that I only have one MMR shot, which I received one year after my birth. I never received other MMR shots. On the day of the medical back in Italy, the Panel Physician determined that I did not need a second one. However, the blanket waiver section on DS-3025 was left blank. I read experiences from other applicants getting an RFE for missing vaccinations - would that be my case as well? I also have with me the results of immunoglobulin blood tests for measles, mumps, and rubella that I took in Italy during my yearly checkup. They show that my immunity levels are high, but I now understand that any test or result from foreign countries will not be valid. What are my next steps? Do I really have to contact a civil surgeon and have the medical exam again? Is it possible to visit a civil surgeon only to have a second shot and avoid to do the same medical ($$$) test I did 3 months ago? Thanks
  6. My fiancé is Canadian and is struggling to get her medical records for the vaccinations. Apparently there are a few that they will not give her because they only give them to the elderly, are all of the vaccinations on the Consulate website a requirement? Is there any way to contact the consulate and ask them about the vaccinations that are absolutely needed? (There’s like 4 she is being told she can’t get)
  7. Hi there. We are about to start our process. I've read so many posts about the Melichor (or something like that) doctor , saying she pretty much FORCES you to get the vaccines there with her clinic at a VERY HIGH COST. 1* Is there anyone who had the vaccines OUTSIDE her Clinic (other clinics, MINSA, etc) ? 2* Which vaccines are mandatory for the K1 visa ( I read somewhere : influenza, tb, hepatitis and neumococo, true?) ? Thank you so very much! Dee
  8. Hi, We are more than a little confused about some items for my husband's upcoming Medial Exam and Visa Interview in Paris, France. I am a US citizen, and the petitioner, and we have done everything ourselves up to this point. Can anyone definitively assist us in determining the following: 1) Which vaccines are absolutely required to be current (within the last 10 years) at the time of the Medical Exam for an applicant that is in their 50's? 1A) My husband has lost his MMR and other vaccination records, will a report of blood tests for specific vaccines be enough for the Exam? 2) Does an applicant need to disclose their HIV status to the civil surgeon at the medical exam? It says in the instructions to be prepared to discuss current medications and conditions the applicant has, but that HIV is not a disqualifying condition anymore, but we are more concerned for the sake of medical privacy to not provide unnecessary medical information if we don't need to. 3) Where is the Medical Questionnaire for the medical exam located? Or is it form I-693 that we just print and bring with us? 4) Any moral support or words of comfort to ease the nervousness of this pending ordeal would be greatly appreciated!
  9. I'm having some trouble getting my vaccinations scheduled via my GP. At first I was told I could just schedule them in with a nurse, but they have now said that since it is classed as a travel immunisation, I will need to go elsewhere and get it done privately. They didn't even offer for me to have it done at the GP surgery for a fee. I did explain that I am going over there to live, and not to travel. I know plenty of people on here have had no issue getting them done at their GP at much reduced cost - or even for free. I looked at private clinics and they cost around the same as Knightsbridge. Is there any argument I can use with my GP surgery in order to get the vaccinations done a reduced cost, rather than having to go privately? Every penny counts at the moment with all the visa costs and I'd rather not pay £100 for jabs if I don't have to. Any advice would be most appreciated.
  10. I'm currently finishing the K1 process but I have a question about the AOS medical. I had my medical in London on 05/09/2018 so at the time it was out of flu season and therefore they didn't give me a flu vaccination. My interview isn't until 17/10/2018 (which is in flu season) so I emailed the medical centre to check and they basically said that now it is flu season I will need to get one or be prepared to get one for AOS. Therefore, I got the flu vaccination done in the UK on 13/10/2018 so that I'm ready but since it is after my medical it's not on my DS-3025. I have got evidence from the pharmacy that gave me the flu vaccination to prove I've had it though. So my question is whether I will need to see a civil surgeon in the US before we submit the AOS documents to get them to sign off on the form i693 that I've had it? I wanted to be able to use the results of my medical in the UK for my AOS (as I told them at the medical so they would ensure everything is ticked off) but it seems they might have overlooked this. Has anyone else had this and found out what USCIS want you to do? I don't want to pay to see a civil surgeon if I don't need to, but I also don't want to exclude it from my application and then get a RFE later down the line because of it, so I was hoping someone might be able to help! Thanks in advance for any advice!
  11. Hi sorry if this has been asked before struggling to find the right answer uscis site says one thing uk us embassy says another, the immigration medical form another. what do I need?
  12. Hi all, I had my marriage-based AOS interview on August 30th. All went well - we didn't get many questions, it was over quickly and the officer told us he was recommending our application for approval, and handed us the letter. He did seem new and inexperienced, but I wasn't too worried. I told him we were leaving the country in a week and asked if I needed a stamp in my passport - he told me no. Not wanting to persist, we left. Then I had a phone call from him, saying that in fact I DID need the stamp, as my EAD/AP would become invalid once the GC was approved. So we drove back to the field office (Atlanta). On the way there, I get another call telling me that the system won't let him approve the GC application because I am 'missing vaccinations'. I deferred my flu shot during my London medical in April 2017. I didn't get one before my GC interview as it was not flu season, so I physically couldn't. So I asked him what I need to do now (full medical again or just vaccination transcription?). He says he's not sure, but he will look into it and send an RFE that will arrive in 2 weeks. So we head back home again. Lo and behold, 4 weeks later nothing has arrived. I speak to two USCIS representatives this morning (am transferred to higher level) and neither could tell me anything. They said nothing on my account indicated that an RFE had been sent out or was required. Second officer submitted a service request to find an update on GC status - but I don't know whether that will tell me anything new. If anyone has been through anything similar post-interview, please let me know. I am feeling disheartened as I thought we were close to this process being over - but now it seems it could go on indefinitely... Many thanks.
  13. Hello Everyone, I'm curious to know whether the hospital keep the vaccination booklet (the one from childhood) with them/copy it OR forward it to the embassy? I'm assuming the use it purely just for info and give it back? Thank you!
  14. He went to his doctor in Yakutsk and they've lost his records. He's been back 3 times but no luck and our NOA2 is in September. I suppose there is nothing left but for him to have absolutely everything done again. Any other options or ideas? He was trying to get proof of previous vaccinations and to take the needed vaccines from his local physician because it's our understanding that we must pay for each needed vaccines on top of the $260 medical fee.
  15. Hello, I have a question regarding vaccinations in the USA, I require 2 vaccinations before I can file for AOS. I spoke with a lady at the civil surgeon's office who informed me I had to have my vaccinations done at the local health clinic and then schedule a physical for $400 with the civil surgeon. I was under the impression that it was the civil surgeon who had to administer my vaccinations and I didn't think I would have to take another physical, what's my next step? Any help is appreciated.
  16. Just need help finding the section on Visa Journey that allows me to view applicants with similar timelines to when I applied. Also if anyone knows of an exemption to avoid the flu shot. Thank you
  17. Anyone get their medicals in Houston? What to expect? approximated cost? any location that can recommend to me? I am a AOS filler and just receive a courtesy letter regarding my medical, I didn't send it with the Original submission of my AOS package because was scared about expiration of the medicals.
  18. Good day all So i've been here in the US for a couple of months now and i'm trying to get my AOS packet together a couple of questions: Do people tend to include relationship evidence in this packet or do they wait til an interview? I''ve noticed nobody mentioning it, so i just want to confirm. I had my medical in London in March and all i required was a tetanus booster which i elected to have from my local GP afterwards (saving myself some money i thought at the time) however this of course means my DS-3025 has my last tetanus as being over 10 years ago. I have a letter from my GP to prove i had the booster since. Do i still need to go see a Civil Surgeon? Frustrated at the thought of having to spend $300 on something when i thought i was saving money previously... Thanks in advance!
  19. I just finished my K1 medical today in Hyderabad, India. I was expecting to get some vaccinations. I've received them all as a kid but have no record of receiving them. The panel physician told me that vaccinations are not required for K1 visas (and a quick search on these forums confirmed that). He also said, "I'll write you a waiver so that you can show that to immigration when you enter." What does this mean? Will I still need to get all the vaccinations when I file for the AOS? I rather do that here than the USA...wayyy cheaper. And do I go to any doctor to get the shots or does it have to be a USA consulate appointed physician? Anybody else who's not been required to take any shots despite having no vaccination records?
  20. Hi, UK young adult looking to move to the US here on a K-1 Visa. I have a question about the vaccination requirements. I received Parts 1, 2 and 3 of the Pertussis/Whooping Couch vaccine, however I didn't have a booster at all, so my last shot for this was when I was 4 months old. I am up to date on Polio, Tetanus and Diphtheria, having had a booster for this a week ago. I have also received the MMR vaccinations. Do I need to go and get the Pertussis booster done privately (not available on NHS), or am I okay because I received the initial vaccination as a baby. Thanks
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