DGMQ Home > Medical Examinations of Aliens > Technical Instructions, Information, and Updates > Department of State Forms
Instructions to Panel Physicians for Completing New U.S. Department of State Medical Examination for Immigrant or Refugee Applicant (DS-2053) and Associated Worksheets (DS-3024, DS-3025, and DS-3026)
Please note: this page provides instructions for completing specific Department of State forms. The forms are not available on this website. Additional information about the forms is provided by the U.S. Department of State.
All immigrant and refugee applicants must have a physical examination and mental status assessment as part of their application process. The purpose of the migration health assessment is to determine if medical conditions or mental disorders exist that would:
- Make the applicant inadmissible.
- Need to be followed up after resettlement.
- Require the applicant to receive long-term institutionalization or maintenance income provided by the U.S. government after resettlement that is to become a public charge (1).
The Centers for Disease Control and Prevention (CDC) has the authority to:
- Develop the methods to identify inadmissible conditions on health-related grounds (2).
- Develop methods to identify applicants who have medical conditions that have the potential to make them become public charges (3). Resettled applicants in whom these medical conditions are identified and treated early will have fewer complications and reduced risk of becoming public charges.
The process by which immigrant and refugee applicants are evaluated and classified includes five components: past medical history, physical examination, chest radiograph (X-ray), laboratory tests, and immunization assessment. Panel physicians are responsible for the entire process and, because determining the final classifications can be complex, worksheets have been developed by the Centers for Disease Control and Prevention, Division of Global Migration and Quarantine and the Department of State to assist them in the process. These instructions are intended to assist panel physicians in using these new forms so that required information is provided for every U.S.-bound immigrant and refugee.
The MEDICAL EXAMINATION FOR IMMIGRANT OR REFUGEE APPLICANT (DS-2053) is the summary page of the worksheets (DS-3024, DS-3025, and DS-3026) and includes the results of the routine laboratory tests. Therefore, the use of the worksheets will be explained first.
For medical updates and clarifications to the new forms, see www.cdc.gov/ncidod/dq/technica.htm.
For fraud prevention, each applicant (immigrant or refugee) is required to have three signed photographs that have been verified by the panel physician or a member of the physician's professional staff by comparing them with the applicant and his or her photograph in an official document such as a passport or letter from the International Organization for Migration. One photograph needs to be attached to the Medical Examination for Immigrant or Refugee Applicant (DS-2053), one to the request slip for routine (syphilis and HIV) laboratory testing, and one to the request for chest radiograph (X-ray) or to the Chest X-ray and Classification Worksheet (DS-3024).
80KB/18 pages)