In accordance with U.S. law (Immigration and Nationality Act and the Public Health Service Act) and Department of Health and Human Services regulations, a medical examination is required for all refugees accepted to resettle in the U.S. The examination is designed to identify individuals with health conditions that prevent entry into the U.S. as defined by public health regulation. The Centers for Disease Control and Prevention (CDC) Division of Global Migration and Quarantine (DGMQ) is responsible for providing the Technical Instructions for the examination.

The medical examination is conducted by panel physicians appointed by the U.S. consul or, in the case of large refugee movements, the International Organization of Migration (IOM). In 2010, approximately 85% of refugee examinations were completed by the IOM.

The inadmissible health conditions include communicable diseases of public health significance (tuberculosis [TB], syphilis and other sexually transmitted infections, and Hansen’s Disease [leprosy]), drug addiction, and physical or mental disorders with harmful behaviors. These diseases and conditions are designated as “Class A”. Refugees with Class A conditions are prevented from travel to the U.S. unless they undergo treatment and no longer pose harm (for example, complete treatment for TB). In some situations, a waiver may allow a refugee to travel to the U.S. despite a Class A condition.

The overseas medical examination also helps to identify physical or mental abnormalities, diseases, or disabilities serious in degree or permanent in nature that amount to a substantial departure from normal well-being. These “Class B” conditions require follow-up soon after arrival in the U.S.

Findings from the overseas medical examination are reported on Department of State forms – the DS-2053, DS-2054, DS-3024, DS-3030, DS-3025, and DS-3026. Refugees carry the DS forms and chest x-ray to the U.S.

After the refugee enters the U.S., the CDC informs public health authorities in the receiving state on the details of the overseas medical examination via the Electronic Disease Notification (EDN) system.