USCIS Civil Surgeon Designation Knowledge Assessment — Questions and Answers

Question 1: What information must be documented when a civil surgeon determines an applicant has a Class A mental health condition?

A referral to a psychiatrist and a follow-up appointment date
Only the diagnosis name
The specific diagnosis, the nature of the harmful behavior, and supporting clinical observations (Correct answer)
The applicant's self-reported psychiatric history

Correct answer: The specific diagnosis, the nature of the harmful behavior, and supporting clinical observations

A Class A mental health finding requires the diagnosis, a description of the harmful behavior that qualifies it as Class A, and clinical observations supporting the determination.

Question 2: How long is a completed Form I-693 valid after the civil surgeon signs it?

Indefinitely until USCIS requests a new one
2 years from the date of the civil surgeon's signature (Correct answer)
6 months from the date of filing
1 year from the date of the exam

Correct answer: 2 years from the date of the civil surgeon's signature

Form I-693 is valid for 2 years from the date the civil surgeon signs and dates the form.

Question 3: How should a civil surgeon handle an applicant who provides a foreign vaccination record?

Reject all foreign vaccination records and revaccinate
Only accept US-issued vaccination records
Accept it if it meets ACIP standards and is adequately documented (Correct answer)
Forward records to CDC for verification before accepting

Correct answer: Accept it if it meets ACIP standards and is adequately documented

Foreign vaccination records may be accepted if they document vaccines that meet ACIP standards and the records appear reliable.

Question 4: Which of the following physicians CANNOT perform immigration medical exams in the United States?

A USCIS-designated civil surgeon with a D.O. degree
A family physician designated as a civil surgeon
A board-certified internist who is also a designated civil surgeon
A licensed US physician who has not been designated by USCIS as a civil surgeon (Correct answer)

Correct answer: A licensed US physician who has not been designated by USCIS as a civil surgeon

Only USCIS-designated civil surgeons may perform immigration medical exams; a licensed physician who lacks USCIS designation is not authorized.

Question 5: What is the significance of the civil surgeon's signature and date on Form I-693 for validity purposes?

USCIS determines validity from the date of the blood draw, not the signature
The form is valid from the date the applicant submits it to USCIS
The date only affects the vaccination record section
The signature and date start the 2-year validity clock for the form (Correct answer)

Correct answer: The signature and date start the 2-year validity clock for the form

The 2-year validity period of Form I-693 begins on the date the civil surgeon signs the form, making the signature date critical for determining expiration.

Question 6: Who is authorized to perform the immigration medical examination for applicants adjusting status inside the United States?

USCIS-designated civil surgeons only (Correct answer)
Any licensed physician
State health department physicians
Any board-certified internist

Correct answer: USCIS-designated civil surgeons only

Only USCIS-designated civil surgeons are authorized to perform immigration medical examinations for applicants adjusting their status within the United States.

Question 7: A physician has been designated as a civil surgeon but moves to a different city. What must they do to continue performing immigration exams at the new location?

Obtain a new state medical license only
No action is needed; the designation is valid nationwide
Notify USCIS of the change of address to update their designation information (Correct answer)
Reapply for civil surgeon designation from scratch

Correct answer: Notify USCIS of the change of address to update their designation information

Civil surgeons must keep their contact information with USCIS current, including notifying USCIS of address changes, to maintain accurate designation records.

Question 8: An immigration applicant tests positive on the initial RPR syphilis screen. What is the next required step?

Repeat the RPR test twice before confirming
Perform a confirmatory treponemal test (e.g., FTA-ABS or TP-PA) (Correct answer)
Refer to infectious disease specialist before completing Form I-693
Immediately classify as Class A and recommend treatment

Correct answer: Perform a confirmatory treponemal test (e.g., FTA-ABS or TP-PA)

A reactive RPR must be confirmed with a treponemal-specific test to distinguish true syphilis from biological false-positive reactions.

Question 9: If a civil surgeon identifies possible mental health concerns beyond their expertise, what should they do?

Refer the applicant to a licensed mental health professional for further evaluation before completing Part 5 of Form I-693 (Correct answer)
Complete the form based on their initial impression only
Defer the entire exam until the applicant provides psychiatric records
Automatically classify the applicant as Class A

Correct answer: Refer the applicant to a licensed mental health professional for further evaluation before completing Part 5 of Form I-693

Civil surgeons who identify mental health concerns requiring expert assessment should refer to a mental health professional before completing the mental health portion of Form I-693.

Question 10: What should a civil surgeon do if an adult applicant has no vaccination records and no serologic evidence of immunity?

Mark the applicant as inadmissible pending vaccination
Vaccinate according to the catch-up immunization schedule (Correct answer)
Defer vaccination to the applicant's personal physician
Skip vaccinations if the applicant is over 18

Correct answer: Vaccinate according to the catch-up immunization schedule

Without documentation or serologic proof of immunity, the civil surgeon must administer vaccines per the ACIP catch-up schedule.

Question 11: What does USCIS require a civil surgeon to do before examining a minor applicant without a parent or legal guardian present?

Proceed with the exam if the minor is over age 14
Contact USCIS for special authorization
Refuse to conduct the examination
Ensure a parent or guardian provides written consent and ideally is present, or follow applicable legal requirements (Correct answer)

Correct answer: Ensure a parent or guardian provides written consent and ideally is present, or follow applicable legal requirements

Minors generally require parental or guardian consent before a medical examination; civil surgeons should follow applicable legal and ethical consent requirements.

Question 12: Who appoints Civil Surgeons in the United States?

American Medical Association (AMA)
U.S. Department of Health
U.S. Citizenship and Immigration Services (USCIS) (Correct answer)
Centers for Disease Control and Prevention (CDC)

Correct answer: U.S. Citizenship and Immigration Services (USCIS)

USCIS designates Civil Surgeons to perform medical exams for immigration applicants.

Question 13: How do Pediatricians typically approach treatment?

With a focus on physical health only
By considering the family and social context (Correct answer)
With a one-size-fits-all approach
By treating only the symptoms

Correct answer: By considering the family and social context

Pediatricians typically approach treatment holistically, considering not only the child's physical health but also their family dynamics, social environment, and developmental stage. This comprehensive approach ensures that care plans are tailored to the child's unique circumstances and support their overall well-being.

Question 14: A past history of drug abuse that is now in full sustained remission should be documented as which class on Form I-693?

Class C – Drug History, Resolved
No notation needed if fully resolved
Class A – Drug Abuse
Class B – Drug Abuse, in Remission (Correct answer)

Correct answer: Class B – Drug Abuse, in Remission

A history of drug abuse in sustained remission is classified as Class B on Form I-693, which is notable but not grounds for inadmissibility.

Question 15: Who designates Designated Physicians?

Local health departments
USCIS (Correct answer)
The Department of State
The Centers for Disease Control and Prevention (CDC)

Correct answer: USCIS

Designated Physicians (civil surgeons) are designated by U.S. Citizenship and Immigration Services (USCIS). USCIS maintains a list of approved physicians who can perform immigration medical examinations for applicants residing in the United States, ensuring they meet specific criteria and follow established guidelines.

Question 16: What is the definition of a Class B medical condition in the context of USCIS immigration medical examinations?

A condition that automatically makes an applicant inadmissible
A condition requiring immediate hospitalization before immigration approval
A physical or mental health condition that is of public health significance but does not meet Class A criteria (Correct answer)
A condition that permanently bars an applicant from obtaining a waiver

Correct answer: A physical or mental health condition that is of public health significance but does not meet Class A criteria

Class B conditions are physical or mental health conditions that are of public health significance but do not rise to the level of a Class A condition and do not by themselves render an applicant inadmissible.

Question 17: What is the civil surgeon's responsibility regarding record retention for Form I-693?

Keep a copy of Form I-693 in the applicant's file for at least 2 years (Correct answer)
Retain indefinitely in a USCIS-approved database
Send a copy to CDC within 30 days
No retention required after submission

Correct answer: Keep a copy of Form I-693 in the applicant's file for at least 2 years

Civil surgeons are required to retain a copy of Form I-693 in the applicant's records for a minimum of 2 years.

Question 18: What serological test is required for applicants 15 years of age and older during the immigration medical examination?

Gonorrhea culture
Syphilis serology (RPR or VDRL) (Correct answer)
HIV antibody test
Hepatitis B surface antigen

Correct answer: Syphilis serology (RPR or VDRL)

Syphilis serology using RPR or VDRL testing is required for all applicants 15 years of age and older as part of the USCIS immigration medical examination.

Question 19: In what manner must Form I-693 be submitted to USCIS?

Mailed directly to USCIS by the civil surgeon
Faxed to the USCIS field office
In a sealed envelope signed by the civil surgeon across the seal (Correct answer)
Scanned and uploaded to the USCIS online portal by the applicant

Correct answer: In a sealed envelope signed by the civil surgeon across the seal

The completed Form I-693 must be given to the applicant in a sealed envelope with the civil surgeon's signature across the seal to maintain confidentiality and integrity.

Question 20: Under what circumstances does a mental disorder constitute a Class A condition for immigration purposes?

Whenever any DSM-5 diagnosis is present
When the applicant takes any psychotropic medication
Only when the applicant has been hospitalized for psychiatric care
When the disorder is associated with harmful behavior or a history of harmful behavior (Correct answer)

Correct answer: When the disorder is associated with harmful behavior or a history of harmful behavior

A mental disorder is a Class A condition only when it is associated with harmful behavior (to self or others) or there is a history of such behavior.

Question 21: Can an applicant review their completed Form I-693 before it is sealed by the civil surgeon?

No, the form is confidential and cannot be shown to the applicant
Only if the applicant requests a copy in writing
Only the applicant's attorney may review it
Yes, the applicant has the right to review and ask questions before sealing (Correct answer)

Correct answer: Yes, the applicant has the right to review and ask questions before sealing

The civil surgeon should review the findings with the applicant prior to sealing the form, allowing the applicant to ask questions about their results.

Question 22: Which tuberculosis testing method is preferred by USCIS Technical Instructions for the immigration medical examination?

Interferon-Gamma Release Assay (IGRA) such as QuantiFERON-TB Gold (Correct answer)
Tuberculin Skin Test (TST/Mantoux) only
Chest X-ray alone
Sputum culture for Mycobacterium tuberculosis

Correct answer: Interferon-Gamma Release Assay (IGRA) such as QuantiFERON-TB Gold

IGRA tests such as QuantiFERON-TB Gold are preferred over TST in the USCIS Technical Instructions because they have higher specificity and are not affected by prior BCG vaccination.

Question 23: What should a civil surgeon do if an applicant presents with documented proof of prior vaccination series completed abroad?

Disregard foreign vaccination records and start the series fresh
Refer the applicant to the CDC for verification of foreign vaccination records
Require all vaccinations to be repeated regardless of prior documentation
Accept valid written documentation and record it on Form I-693 without repeating vaccines (Correct answer)

Correct answer: Accept valid written documentation and record it on Form I-693 without repeating vaccines

Civil surgeons may accept valid written documentation of vaccinations completed abroad and record them on Form I-693, avoiding unnecessary repeat vaccinations when records meet acceptability standards.

Question 24: Which section of Form I-693 records the results of the tuberculosis evaluation?

Part 1 – Applicant Information
Part 6 – Vaccination Record
Part 2 – Medical History
Part 4 – Tuberculosis (TB) Evaluation (Correct answer)

Correct answer: Part 4 – Tuberculosis (TB) Evaluation

Part 4 of Form I-693 is dedicated to recording all tuberculosis evaluation findings, including TST and IGRA results.

Question 25: What standard diagnostic manual does USCIS instruct civil surgeons to use when classifying mental disorders?

ICD-10 only
DSM (Diagnostic and Statistical Manual of Mental Disorders) (Correct answer)
WHO Classification of Mental Disorders
NIMH Diagnostic Guidelines

Correct answer: DSM (Diagnostic and Statistical Manual of Mental Disorders)

Civil surgeons are instructed to use DSM criteria when classifying mental disorders for the immigration medical evaluation.

Question 26: Which condition found during the immigration medical examination is an absolute Class A bar to admissibility with no waiver available?

History of alcohol use disorder in remission
Controlled schizophrenia without harmful behavior
Active tuberculosis that is contagious (Correct answer)
Latent tuberculosis infection (LTBI)

Correct answer: Active tuberculosis that is contagious

Active, contagious tuberculosis is a Class A communicable disease of public health significance that renders an applicant inadmissible, and treatment and proof of cure are required before a waiver can be considered.

Question 27: Can an applicant receive a waiver for a Class A mental health or substance abuse condition?

Only if the condition is in complete remission for 10 years
Yes, waivers may be granted by USCIS under specific circumstances (Correct answer)
Only if the applicant agrees to mandatory treatment in the US
No, Class A mental health conditions are never waivable

Correct answer: Yes, waivers may be granted by USCIS under specific circumstances

USCIS may grant waivers for Class A mental health and substance abuse conditions, taking into account factors such as remission, treatment history, and public safety.

Question 28: If a civil surgeon suspects an applicant has an active communicable disease of public health significance, what immediate action is required?

Issue Form I-693 with a Class A notation and allow the applicant to seek treatment independently
Complete the form and include a note suggesting follow-up
Contact USCIS directly to have the applicant detained
Refer the applicant for further evaluation and do not issue Form I-693 until the workup is complete (Correct answer)

Correct answer: Refer the applicant for further evaluation and do not issue Form I-693 until the workup is complete

When a Class A communicable disease is suspected, the civil surgeon must complete a thorough workup before completing Form I-693, not issue an incomplete form.

Question 29: For meningococcal vaccine, at what age does it become required for immigration exams?

11 years (Correct answer)
18 years
21 years
16 years

Correct answer: 11 years

Meningococcal vaccine (MenACWY) is required beginning at age 11 as part of the adolescent immunization schedule.

Question 30: What must a civil surgeon certify by signing Form I-693?

That the applicant is admissible to the United States
That the examination was performed and the results are accurate and complete to the best of their knowledge (Correct answer)
That all laboratory tests were personally performed by the civil surgeon
That the applicant has received all required vaccinations

Correct answer: That the examination was performed and the results are accurate and complete to the best of their knowledge

By signing Form I-693, the civil surgeon certifies that they performed the examination and that all information recorded is accurate and complete to their best knowledge.

Question 31: Which government agency grants civil surgeon designation to physicians in the United States?

American Medical Association (AMA)
Centers for Disease Control and Prevention (CDC)
Department of Health and Human Services (HHS)
U.S. Citizenship and Immigration Services (USCIS) (Correct answer)

Correct answer: U.S. Citizenship and Immigration Services (USCIS)

USCIS designates civil surgeons through its field offices; it is not the CDC or AMA that grants this specific immigration-exam authority.

USCIS Civil Surgeon Designation Knowledge Assessment

Evaluates physician knowledge of USCIS immigration medical examination requirements, including Form I-693 completion, infectious disease screening, mental health evaluation, vaccination requirements, and CDC Technical Instructions for civil surgeons.

Questions

35 min

Time Limit

70%

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