ed appropriate inpatient or outpatient treatment. If the diagnosis is not confirmed, the patient shall be discharged.

[40 FR 25816, June 19, 1975; 40 FR 36774, Aug. 22, 1975]

§ 32.88 Examinations and treatment.

Patients will be provided necessary clinical examinations which may be required for the diagnosis of primary or secondary conditions, and such treatment as may be prescribed.

§ 32.89 Discharge.

Patients with Hansen's disease will be discharged when, in the opinion of the medical staff of the hospital, optimum hospital benefits have been received.

§ 32.90 Notification to health authorities regarding discharged patients.

Upon the discharge of a patient the medical officer in charge shall give notification of such discharge to the appropriate health officer of the State, Territory, or other jurisdiction in which the discharged patient is to reside. The notification shall also set forth the clinical findings and other essential facts necessary to be known by the health officer relative to such discharged patient.

§ 32.91 Purchase of Services for Hansen's Disease Patients.

Hansen's disease patients being treated on either an inpatient or outpatient basis at a hospital or clinic facility of the Service, other than the National Center for Hansen's Disease (Carville, Louisiana), may, at the sole discretion of the Secretary and subject to available appropriations, be provided care for the treatment of Hansen's disease at the expense of the Service upon closure or transfer of such hospital or clinic pursuant to section 987 of the Omnibus Budget Reconciliation Act of 1981 (Pub. L. 97-35). Payment will only be made for care arranged for by an authorizing official of the Service as defined in § 32.1(f) of this part.

[46 FR 51918, Oct. 23, 1981]

NONBENEFICIARIES: TEMPORARY TREATMENT IN EMERGENCY

§ 32.111 Conditions and extent of treatment; charges.

(a) Persons not entitled to treatment by the Service may be provided temporary care and treatment at medical care facilities of the Service in case of emergency as an act of humanity.

(b) Persons referred to in paragraph (a) of this section who, as determined by the officer in charge of the Service facility, are able to defray the cost of their care and treatment shall be charged for such care and treatment at the following rates (which shall be deemed to constitute the entire charge in each instance): In the case of hospitalization, at the current interdepartmental reciprocal per diem rate; and, in the case of outpatient treatment, at rates established by the Secretary.

PART 34-MEDICAL EXAMINATION OF ALIENS

Sec.

34.1 Applicability. 34.2 Definitions.

34.3 Examinations; female aliens.

34.4 Scope of examinations.

34.5 Aliens free of defect, disease, or disability.

34.6 Aliens afflicted with defect, disease, or disability.

34.7 Certificates and notifications; Class A. 34.8 Certificates and notifications; Class B. 34.9 Class A or Class B certificates; helpless aliens.

34.10 Certificates and notifications; Class C.

34.11 Deferral of examinations; adequacy of facilities.

34.12 Applicability of Foreign Quarantine Regulations.

34.13 Medical and other care; death. 34.14 Reexamination; convening of boards; expert witnesses; reports.

AUTHORITY: Sec. 215, 58 Stat. 690, as amended, sec. 234, 66 Stat. 198; 42 U.S.C. 216, 8 U.S.C. 1224; secs. 322, 325, 58 Stat. 696, as amended, 697 as amended, secs. 212, 326, 66 Stat. 182, as amended, 200; 42 U.S.C. 249, 252, 8 U.S.C. 1182, 1226; sec. 518 of Pub. L. 100-71.

SOURCE: 21 FR 9829, Dec. 12, 1956, unless otherwise noted.

§ 34.1 Applicability.

The provisions of this part shall apply to:

(a) The medical examination of (1) aliens applying for a visa at a consulate of the United States, (2) aliens arriving in the United States, and (3) aliens presented or referred by the Immigration Service in connection with determination of their admissibility into the United States, and

(b) The medical and other care, and burial, of aliens admitted to Public Health Service stations and hospitals at the request of the Immigration Service.

(1) Chancroid.

(2) Gonorrhea.

(3) Granuloma inguinale.

(4) Human immunodeficiency virus (HIV) infection.

(5) Leprosy, infectious.

(6) Lymphogranuloma venereum.
(7) Syphilis, infectious stage.
(8) Tuberculosis, active.

(c) Medical certificate. A document issued to the Immigration Service by a medical examiner, reporting the presence of any physical or mental defect, disease, or disability, or the previous occurrence of one or more attacks of insanity, in an alien.

(d) Medical notification. A document issued to a consular authority by a medical examiner, reporting the presence of any physical or mental defect, disease, or disability or the previous occurrence of one or more attacks of insanity, in an alien. Medical notification shall be made on the form prescribed for reporting the results of the medical examination of applicants for visas.

(e) Medical officer. A physician of the Public Health Service assigned or detailed by the Surgeon General of the Public Health Service to make mental and physical examinations of aliens.

(f) Medical officer in charge. A medical officer charged by the Surgeon General with responsibility for the conduct and supervision of all medical examinations made at a designated place or in a designated area.

[21 FR 9829, Dec. 12, 1956, as amended at 26 FR 9856, Oct. 20, 1961; 35 FR 15289, Oct. 1, 1970; 52 FR 32543, Aug. 28, 1987]

§ 34.3 Examinations; female aliens.

Female aliens shall be examined only in the presence of a female nurse or other female, or by a female physician.

§ 34.4 Scope of examinations.

(a) General. In performing examinations and reexaminations, medical examiners shall give consideration to only those matters that relate to the physical or mental condition of the alien and shall issue certificates or notifications of a defect, disease, or disability or previous occurrence of one or more attacks of insanity as hereinafter provided only if the presence of such defect, disease, or disability or previous occurrence of one or more attacks of insanity has been clearly established.

(1) Persons subject to requirement for chest X-ray examination and serologic testing. Except as provided in paragraph (a)(2) of this section, a chest X-ray examination for tuberculosis and serologic test for syphilis and serologic testing for HIV shall be required as part of the examination of:

(i) All applicants for immigrant visas;

(ii) All students and exchange visitors who are required by a consular authority to have a medical examination upon application for a nonimmigrant visa;

(iii) All other applicants for a nonimmigrant visa who are required by a consular authority to have a medical examination if such X-ray examination and serologic testing are considered necessary by the medical examiner; and

(iv) All aliens outside the United States who apply for conditional entry and all aliens in the United States who apply for adjustment of status, under the immigration laws and regulations.

(2) Exceptions. Neither a chest Xray examination nor serologic testing for syphilis and HIV shall be required if the alien is under the age of 15: Provided, That a tuberculin test may be required where there is evidence of contact with a known case of tuberculosis or other reason to suspect infection with tuberculosis and a chest Xray examination required in the event of a positive reaction, and serologic testing where there is reason to suspect infection with syphilis or HIV. Additional exceptions to the requirement for a chest X-ray examination may be authorized for good cause upon application approved by the Director, Center for Disease Control, Health Services and Mental Health

Administration.

(3) How and where performed. (i) All X-ray films used in medical examinations performed under the regulations in this part shall be at least 70mm. In case of abnormal findings in the lungs, a full-sized film (approximately 14 x 17 inches; 35.6 x 43.2 cm.) shall be used on which to base the diagnosis. Serologic testing for HIV shall be a sensitive and specific test, confirmed when positive by a test such as the Western blot blood test or an equally reliable test.

(ii) When necessary X-ray and laboratory facilities are not available to the medical examiner, the applicant shall furnish a chest X-ray film, a reading thereof, and a report of serologic testing for syphilis in order that the medical examination may be completed. If X-ray or serologic testing facilities for syphilis necessary for the completion of the examination of a visa applicant or of an applicant for entry are not available in the community where the examination is made, the medical examiner shall so state on the medical examination form and the procedures will be completed at the time of examination at the U.S. port of entry. For aliens examined abroad, the serologic testing for HIV must be completed abroad, except that the Attorney General after consultation with the Secretary of State and the Secretary of Health and Human Services may in emergency circumstances permit the serologic testing of refu

gees for HIV to be completed in the United States.

(iii) The X-ray reading and reports of serologic testing for syphilis and HIV shall be included in the medical examination report. When the medical examiner's conclusions are based on a study of more than one X-ray film, the medical examination report shall include at least a summary statement of findings in the earlier films, followed by a complete reading of the last film, and dates and details of any laboratory tests for tuberculosis. (4) Procedure for transmitting records. For aliens issued immigrant visas, the medical examination report shall be placed in a separate envelope which shall be sealed and attached to the alien's visa in such a manner as to be readily detached by the medical examiner at the U.S. port of entry. The X-ray film shall be included in this envelope or, in the case of large films, shall be placed in a separate envelope which shall be sealed and given to the alien for presentation at the port of entry. For aliens issued nonimmigrant visas and for applicants for conditional entry, the medical examination report and the X-ray film shall be placed in an envelope which shall be sealed and given to the alien for presentation at the U.S. port of entry. When more than one X-ray film is used as a basis for the medical examiner's conclusions, all films shall be included. However, the X-ray film or films used in connection with the examination shall not be required to be attached to the visa or otherwise presented to the medical examiner at the U.S. port of entry when an exception to this requirement is authorized by the Director, Center for Disease Control, Health Services and Mental Health

Administration.

(5) Failure to present records. If, on examination at the time determination of admissibility is to be made at the U.S. port of entry, no X-ray film or medical examination report, including X-ray reading and serologic testing results for syphilis and HIV, is presented in accordance with the provisions of this paragraph, a medical hold shall be issued pending completion of any necessary examination procedures.

[21 FR 9829, Dec. 12, 1956, as amended at 30 FR 16112, Dec. 28, 1965; 37 FR 16937, Aug. 23, 1972; 52 FR 32544, Aug. 28, 1987]

EFFECTIVE DATE NOTE: At 52 FR 32544, Aug. 28, 1987, § 34.4 was amended by revising (a)(1) introductory text, (a)(1)(iii), (a)(3) and (5), and the first sentence of (a)(2), effective December 1, 1987. For user convenience, the superceded text reads as follows:

§ 34.4 Scope of examinations.

(a)

(1) Persons subject to requirement for chest X-ray examination and serologic test. Except as provided in paragraph (a)(2) of this section, a chest X-ray examination for tuberculosis and a serologic test for syphilis shall be required as part of the examination of:

(iii) All other applicants for a nonimmigrant visa who are required by a consular authority to have a medical examination if such X-ray examination and serologic test are considered by the medical examiner; and

(2) Exceptions. Neither a chest X-ray examination nor a serologic test for syphilis shall be required if the alien is under the age of 15: Provided, That a tuberculin test may be required where there is evidence of contact with a known case of tuberculosis or other reason to suspect infection with tuberculosis and a chest X-ray examination required in the event of a positive reaction, and a serologic test where there is reason to suspect infection with syphilis.

(3) How and where performed. (i) All Xray films used in medical examinations performed under the regulations in this part shall be at least 70 mm. in size. In case of abnormal findings in the lungs, a full-sized film (approximately 14 x 17 inches; 35.6 x 43.2 cm.) shall be used on which to base the diagnosis.

(ii) When necessary X-ray and laboratory facilities are not available to the medical examiner, the applicant shall furnish a chest X-ray film, a reading thereof, and a serologic test report in order that the medical examination may be completed. If X-ray or serologic test facilities necessary for the completion of the examination of a visa applicant or of an applicant for the community where the examination is made, the medical examiner shall so state on the medical examination form and the procedures will be completed at the time of examination at the U.S. port of entry.

(iii) The X-ray reading and serologic test report shall be included in the medical examination report. When the medical exam

iner's conclusions are based on a study of more than one X-ray film, the medical examination report shall include at least a summary statement of findings in the earlier films, followed by a complete reading of the last film, and dates and details of any laboratory tests for tuberculosis.

(5) Failure to present records. If, on examination at the time determination of admissibility is to be made at the U.S. port of entry, no X-ray film or medical examination report, including X-ray reading and serologic test report, is presented in accordance with the provisions of this paragraph, a medical hold shall be issued pending completion of any necessary examination procedures.

§ 34.5 Aliens free of defect, disease, or disability.

If an alien is found to have no physical or mental defect, disease, or disability and no history of a previous attack of insanity, the medical examiner shall so indicate to the consular or immigration authority concerned.

§ 34.6 Aliens afflicted with defect, disease, or disability.

If an alien is found to have any physical or mental defect, disease, or disability or to have had one or more attacks of insanity, the medical examiner shall report his findings to the Immigration Service by medical certificate or to the consular authority by medical notification.

§ 34.7 Certificates and notifications; Class A.

A Class A certificate or Class A notification shall be issued with respect to aliens who:

(a) Are mentally retarded; (b) Are insane;

(c) Have had one or more attacks of insanity;

(d) Are afflicted with psychopathic personality, sexual deviation, or a mental defect;

(e) Are narcotic drug addicts or chronic alcoholics;

(f) Are afflicted with any dangerous contagious disease: Provided, however, That a Class A certificate or Class A notification of a mental defect, disease, or disability shall in no case be

A Class C certificate or Class C notification shall be issued with respect to an alien who has a defect, disease, or disability other than those for which a Class A or B certificate (or notification) is required to be issued.

§ 34.11 Deferral of examination; adequacy of facilities.

(a) Whenever, upon an examination, it appears to the medical officer in charge that there is doubt about the physical or mental condition of an alien, completion of the examination shall be deferred for such observation and further examination of the alien as may be reasonably necessary to determine his physical or mental condition.

(b) When, in the judgment of the medical officer in charge, a medical examination in the United States or in a territory or possession thereof

cannot be satisfactorily completed at a station or place at which it is undertaken, such examination shall be discontinued and such officer shall request of the Immigration Service that the alien be removed to a place where the examination may be satisfactorily completed.

§ 34.12 Applicability of Foreign Quarantine Regulations.

Aliens arriving at a port of the United States shall be subject to the applicable provisions of Part 71 of this chapter (Foreign Quarantine Regulations of the Public Health Service) with respect to examination and sanitary and quarantine measures.

§ 34.13 Medical and other care; death.

(a) Upon request by the Immigration Service, an alien detained by it shall be admitted to a hospital or station of the Public Health Service and receive therein necessary medical, surgical, and dental care. An alien found to be in need of emergency care in the course of an examination or reexamination in the United States, or in a territory or possession thereof, shall be given such care to the extent deemed practicable by the medical officer in charge, and if in need of further care he shall be referred to the immigration authority concerned, with the medical examiner's recommendations concerning such further care.

(b) In case of death of an alien the body shall be delivered to the consular or immigration authority concerned; but if such death occurs in the United States, or in a territory or possession thereof, public burial shall be provided upon request of the Immigration Service and subject to its agreement to pay the burial expenses. Autopsies shall not be performed unless approved by the Immigration Service.

§ 34.14 Reexamination; convening of boards; expert witnesses; reports.

(a) The Surgeon General or, when authorized, the medical officer in charge, shall convene a board of medical officers to reexamine an alien:

(1) Upon the request of the Immigration Service for a reexamination by such a board, or