USCIS Case Studies & Practical Application 3 — Questions and Answers
Question 1: A civil surgeon discovers during an I-693 exam that a 30-year-old female applicant is pregnant. Several required vaccines (MMR, varicella) are contraindicated in pregnancy. How should the civil surgeon handle the vaccination requirement?
- Administer all required vaccines regardless of pregnancy status
- Document the pregnancy as a contraindication, defer the contraindicated vaccines, and note them as not administered on the I-693; the applicant can complete vaccination postpartum (Correct answer)
- Deny completion of the I-693 until after the pregnancy ends
- Administer only inactivated vaccines and mark the live vaccines as permanent waivers
Correct answer: Document the pregnancy as a contraindication, defer the contraindicated vaccines, and note them as not administered on the I-693; the applicant can complete vaccination postpartum
Pregnancy is a recognized medical contraindication; the civil surgeon documents the deferral and USCIS policy allows completion of deferred vaccines after the pregnancy.
Question 2: An applicant who underwent adjustment of status had an I-693 completed by a civil surgeon 3 years ago, but USCIS never adjudicated the case. The applicant is now refiling. Is the original I-693 still valid?
- Yes, I-693 forms are valid indefinitely once signed by a civil surgeon
- No, the I-693 is valid for 2 years from the date the civil surgeon signed it; a new examination is required (Correct answer)
- Yes, as long as the applicant has not traveled outside the US since the original exam
- No, USCIS requires a new I-693 for every new filing regardless of time elapsed
Correct answer: No, the I-693 is valid for 2 years from the date the civil surgeon signed it; a new examination is required
USCIS policy states the I-693 is generally valid for 2 years from the civil surgeon's signature date; an exam performed 3 years ago would require a new examination.
Question 3: A civil surgeon examines an applicant who has HIV that is well-controlled on antiretroviral therapy with an undetectable viral load. The applicant is otherwise healthy. What is the correct I-693 classification under current USCIS policy?
- Class A inadmissible because HIV is a communicable disease of public health significance
- Class B notification because HIV is no longer a ground of inadmissibility but must still be documented (Correct answer)
- No notation required; HIV status is confidential medical information protected by HIPAA
- Class A inadmissible only if the viral load is above 200 copies/mL
Correct answer: Class B notification because HIV is no longer a ground of inadmissibility but must still be documented
HIV was removed as a ground of inadmissibility in 2010; it is now treated as a Class B condition that must be documented but does not bar admission.
Question 4: During the physical exam, a civil surgeon notes signs of physical abuse on a pediatric applicant (age 8). The parent accompanying the child becomes defensive when questioned. What must the civil surgeon do?
- Complete the I-693 and let USCIS handle child welfare concerns during adjudication
- Report the suspected child abuse to the appropriate state child protective services authority as required by mandatory reporting laws, regardless of immigration consequences (Correct answer)
- Refuse to complete the I-693 and notify USCIS directly of the suspected abuse
- Document the injuries as 'accidental trauma' to avoid complicating the applicant's immigration case
Correct answer: Report the suspected child abuse to the appropriate state child protective services authority as required by mandatory reporting laws, regardless of immigration consequences
Civil surgeons are licensed medical professionals bound by state mandatory reporting laws for suspected child abuse, which supersede immigration process considerations.
Question 5: An applicant seeking adjustment of status is found to have untreated syphilis (reactive RPR, confirmed by treponemal test). The civil surgeon has confirmed the diagnosis. What is the correct I-693 classification and next step?
- Class A; the civil surgeon must complete treatment before signing the I-693 (Correct answer)
- Class B; document and submit the I-693 without treatment since syphilis is no longer grounds for inadmissibility
- Refer to USCIS for determination; the civil surgeon does not classify STIs
- Class A; the civil surgeon should notify the local health department but can still sign the I-693 after treatment initiation
Correct answer: Class A; the civil surgeon must complete treatment before signing the I-693
Syphilis is a Class A communicable disease of public health significance; the civil surgeon must ensure treatment is completed before certifying the I-693.
Question 6: A civil surgeon receives a completed I-693 packet from an applicant who was examined by a different civil surgeon two months ago. The applicant wants the current civil surgeon to review and co-sign it. How should the civil surgeon respond?
- Co-sign the form after reviewing the documentation since two civil surgeon signatures add validity
- Decline; only the civil surgeon who performed the examination may sign the I-693 (Correct answer)
- Accept the form and add an addendum with additional findings from a brief re-examination
- Forward the form to USCIS with a note that the original civil surgeon is unavailable
Correct answer: Decline; only the civil surgeon who performed the examination may sign the I-693
The I-693 must be signed only by the civil surgeon who personally performed the examination; a different physician cannot co-sign or adopt another's exam findings.
Question 7: An applicant with a history of Hansen's disease (leprosy) that was fully treated 10 years ago presents for a civil surgeon exam. Current examination shows no active disease. What is the correct classification?
- Class A because leprosy is permanently inadmissible regardless of treatment history
- Class B notification with documentation of prior treatment; no active disease means no Class A finding (Correct answer)
- No notation required; resolved infectious diseases are not reported on the I-693
- Class A until the applicant provides a letter from the National Hansen's Disease Program
Correct answer: Class B notification with documentation of prior treatment; no active disease means no Class A finding
Hansen's disease that has been adequately treated with no signs of active disease does not support a Class A finding; it is documented as a Class B condition.
USCIS Case Studies & Practical Application 3
A civil surgeon discovers during an I-693 exam that a 30-year-old female applicant is pregnant.
Several required vaccines (MMR, varicella) are contraindicated in pregnancy.
How should the civil surgeon handle the vaccination requirement?