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») Physical disorder. A currently acted medical diagnosis, as defined by

Manual of the International Classiation of Diseases, Injuries, and uses of Death published by the World alth Organization, or by other aubritative sources.

FR 9829, Dec. 12, 1956, as amended at 52 . 325A3, Aug. 28, 1987; 56 FR 25001, May 31, 1) 4.3 Scope of examinations. (a) General. In performing examinaons, medical examiners shall consider lose matters that relate to: (1) A communicable disease of public -alth significance; (2)(i) A physical or mental disorder ad behavior associated with the disrder that may pose, or has posed, a areat to the property, safety, or welure of the alien or others;

(ii) A history of a physical or mental isorder and behavior associated with he disorder, which behavior has posed o threat to the property, safety, or welare of the alien or others and which behavior is likely to recur or lead to other harmful behavior;

(3) Drug abuse or addiction; and

(4) Any other physical abnormality, disease, or disability serious in degree or permanent in nature amounting to a substantial departure from normal well-being. The scope of the examination shall include any laboratory or additional studies that are deemed necessary, either as a result of the physical examination or pertinent information elicited from the alien's medical history, for the examining physician to reach a conclusion about the presence or absence of a physical or mental abnormality, disease, or disability.

(b) Persons subject to requirement for chest X-ray examination and serologic : testing. (1) Except as provided in paragraph (b)(1)(v) of this section, a chest X-ray examination, serologic testing for syphilis and serologic testing for HIV of persons 15 years of age and older shall be required as part of the examination of: (1) Applicants for immigrant visas;

(ii) Students, exchange visitors, and other applicants for a nonimmigrant visa who are required by a consular authority to have a medical examination;

(iii) Aliens outside the United States who apply for refugee status;

(iv) Applicants in the United States who apply for adjustment of status under the immigration statute and regulations;

(v) Exceptions. Neither a chest X-ray examination nor serologic testing for syphilis and HIV shall be required if the alien is under the age of 15. Provided, a tuberculin skin test shall be required if there is evidence of contact with a person known to have tuberculosis or other reason to suspect tuberculosis, and a chest X-ray examination shall be required in the event of a positive tuberculin 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.

(2) Tuberculin skin test examination. (i) All aliens 2 years of age or older in the United States who apply for adjustment of status to permanent residents, under the immigration laws and regulations, or other aliens in the United States who are required by the INS to have a medical examination in connection with a determination of their admissibility, shall be required to have a tuberculin skin test. Exceptions to this requirement may be authorized for good cause upon application approved by the Director. In the event of a positive tuberculin reaction, a chest X-ray examination shall be required. If the chest radiograph is consistent with tuberculosis, the alien shall be referred to the local health authority for evaluation. Evidence of this evaluation shall be provided to the civil surgeon before a medical notification may be issued.

(ii) Aliens less than 2 years old shall be required to have a tuberculin skin test if there is evidence of contact with a person known to have tuberculosis or other reason to suspect tuberculosis. In the event of a positive tuberculin reaction, a chest X-ray examination shall be required. If the chest radice consistent with tuberculosishall be referred to the lo thority for evaluation. P evaluation shall

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civil surgeon before a medical notifica- ination procedures. A medical i tion may be issued.

document may be issued for aliens (3) Sputum smear examination. All (1) Are not in possession of a aliens subject to the chest X-ray exam- medical notification, if required: ination requirement and for whom the (2) Have a medical notification radiograph shows an abnormality con- is incomplete; sistent with pulmonary tuberculosis

(3) Have a medical notification vi shall be required to have a sputum is not written in English; smear examination for acid-fast bacilli.

(4) Are suspected to have an esc (4) How and where performed. All

able medical condition. chest X-ray films used in medical ex

(e) The Attorney General, after a aminations performed under the regu

sultation with the Secretary of Su lations in this part shall be large

and the Secretary of Health enough to encompass the entire chest

Human Services, may in emergen (approximately 14 by 17 inches; 35.6x43.2

circumstances permit the medical cm.). Serologic testing for HIV shall be

amination of refugees to be complet

in the United States. a sensitive and specific test, confirmed

(1) All medical examinations shall when positive by a test such as the

carried out in accordance with so Western blot test or an equally reliable

technical instructions for physicia test. For aliens examined abroad, the

conducting the medical examination serologic testing for HIV must be com

aliens as may be issued by the Dir pleted abroad, except that the Attor

tor. Copies of such technical instru ney General after consultation with

tions are available upon request to ti the Secretary of State and the Sec

Director, Division of Quarantis retary of Health and Human Services

Mailstop E03, CDC, Atlanta GA 30338 may in emergency circumstances permit serologic testing of refugees for

(56 FR 25002, May 31, 1991) HIV to be completed in the United

834.4 Medical notifications. States. (5) Chest X-ray, laboratory, and treat

(a) Medical examiners shall issu

medical notifications of their findin ment reports. The chest X-ray reading and serologic test results for syphilis

of the presence or absence of Class Ad and HIV shall be included in the medi

Class B medical conditions. The pre

ence of such condition must have been cal notification. When the medical examiner's conclusions are based on a

clearly established.

(b) Class A medical notifications. O study of more than one chest X-ray

The medical examiner shall report his film, the medical notification shall in

her findings to the consular officer a clude at least a summary statement of

the INS by Class A medical notifica findings of the earlier films, followed

tion which list the specific condition by a complete reading of the last film,

for which the alien may be excluded, il and dates and details of any laboratory

an alien is found to have: tests and treatment for tuberculosis.

(i) A communicable disease of public (c) Procedure for transmitting records.

health significance; For aliens issued immigrant visas, the (ii)(A) A physical or mental disorder, medical notification and chest X-ray and behavior associated with the dis film, if any, shall be placed in a sepa- order that may pose, or has posed, a rate envelope which shall be sealed and threat to the property, safety, or welattached to the alien's visa in such a fare of the alien or others; or manner as to be readily detached at (B) A history of a physical or mental the U.S. port of entry. When more than disorder and behavior associated with one chest X-ray film is used as a basis the disorder, which behavior has posed for the examiner's conclusions, all a threat to the property, safety, or welfilms shall be included.

fare of the alien or others and which (d) Failure to present records. When a behavior is likely to recur or lead to determination of admissibility is to be other harmful behavior; made at the U.S. Port of entry, a medi

(iii) Drug abuse or addition. cal hold document shall be issued pend- Provided, however, That a Class A med:ing completion of any necessary exam- cal notification of a physical or mental

order, and behavior associated with report his findings to the consular or et disorder that may pose, or has INS officer. sed, a threat to the property, safety,

(56 FR 25003, May 31, 1991) welfare of the alien or others, shall no case be issued with respect to an

§ 34.5 Postponement of medical examen having only mental shortcomings ination. le to ignorance, or suffering only om a condition attributable to reme

Whenever, upon an examination, the

medical examiner is unable to deterable physical causes or of a temrary nature, caused by a toxin, medi

mine the physical or mental condition lly prescribed drug, or disease.

of an alien, completion of the medical (2) The medical notification shall

examination shall be postponed for ate the nature and extent of the ab

such observation and further examinaormality; the degree to which the

tion of the alien as may be reasonably lien is incapable of normal physical

necessary to determine his/her physical ctivity; and the extent to which the

or mental condition. The examination ondition is remediable. The medical

shall be postponed for aliens who have xaminer shall indicate the likelihood,

an acute infectious disease until the hat because of the condition, the ap

condition is resolved. The alien shall licant will require extensive medical

be referred for medical care as necare or institutionalization.

essary. (c) Class B medical notifications. (1) If (56 FR 25003, May 31, 1991) in alien is found to have a physical or mental abnormality, disease, or dis- 834.6 Applicability of Foreign Quar. ability serious in degree or permanent

antine Regulations. in nature amounting to a substantial

Aliens arriving at a port of the Unitdeparture from normal well-being, the ed States shall be subject to the applimedical examiner shall report his/her

cable provisions of 42 CFR part 71, Forfindings to the consular or INS officer

eign Quarantine, with respect to examby Class B medical notification which

ination and quarantine measures. lists the specific conditions found by the medical examiner. Provided, how

(56 FR 25003, May 31, 1991) ever, that a Class B medical notification shall in no case be issued with re

834.7 Medical and other care; death. spect to an alien having only mental (a) An alien detained by or in the shortcomings due to ignorance, or suf- custody of the INS may be provided fering only from a condition attrib- medical, surgical, psychiatric, or denutable to remediable physical causes or tal care by the Public Health Service of a temporary nature, caused by a through interagency agreements under toxin, medically prescribed drug, or which the INS shall reimburse the Pubdisease.

lic Health Service. Aliens found to be (2) The medical notification shall in need of emergency care in the course state the nature and extent of the ab- of medical examination shall be treatnormality, the degree to which the ed to the extent deemed practical by alien is incapable of normal physical the attending physician and if considactivity, and the extent to which the ered to be in need of further care, may condition is remediable. The medical be referred to the INS along with the examiner shall indicate the likelihood, physician's recommendations concernthat because of the condition, the ap- ing such further care. plicant will require extensive medical (b) In case of the death of an alien, care or institutionalization.

the body shall be delivered to the con(d) Other medical notifications. If as a sular or immigration authority conresult of the medical examination, the cerned. If such death occurs in the medical examiner does not find a Class United States, or in a territory or posA or Class B condition in an alien, the session thereof, public burial shall be medical examiner shall so indicate on provided upon request of the INS and the medical notification form and shall subject to its agreement to pay the

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35.22 Attendants.

lusions of prior examining medical Pers.

The board shall issue its medical ification in accordance with the ap-able provisions of this part if it As that an alien it has reexamined -a Class A or Class B condition.

If the board finds that an alien it reexamined does not have a Class A Class B condition, it shall issue its ical notification in accordance 2 the applicable provisions of this

Subpart C-Disposition of Articles

Produced by Patients 35.31 Retention by patients. 35.32 Board of appraisers. 35.33 Sale; prices; deposit of proceeds. 35.34 Resale. 35.35 Unsalable articles.

1-) After submission of its report, the "rd shall not be reconvened, nor ll a new board be convened, in conntion with the same application for mission or for adjustment of status, cept upon the express authorization the Director. FR 25004, May 31, 1991)

Subpart D-Disposal of Money and Effects

of Deceased Patients 35.41 Inventory. 35.42 Notice upon death. 35.43 Delivery only upon filing claim; forms;

procedure. 35.44 Delivery to legal representative; to

other claimants if value is $1,000 or less. 35.45 Disposition of effects; exceptions. 35.46 Conflicting claims. 35.47 Disposition of Government checks. 35.48 Deposit of unclaimed money; sale of

unclaimed effects and deposit of pro

ceeds. 35.49 Sale of unclaimed effects; procedures. 35.50 Disposition of unsold effects. 35.51 Manner of delivery; costs, receipts. 35.52 Delivery of possession only; title unaf

fected.

ART 35-HOSPITAL AND STATION

MANAGEMENT

Subpart A-General

ec. 5.1 Hospital and station rules. 1.2 Compliance with hospital rules. ».3 Noncompliance; deprivation of privi

leges. 5.4 Noncompliance; discharge or transfer. 5.5 Entitlement to care after discharge or

transfer by reason of noncompliance. 35.6 Admissions; determination of eligi

bility for care. 5.7 Admissions; designation of person to be

notified. 35.8 Safekeeping of money and effects; with

drawals. 35.9 Disposition of money and effects left by

other than deceased patients. 35.10 Destruction of effects dangerous to

health. 35.11 Clinical records; confidential. 35.12 Solicitation of legal business prohib

ited. 35.13 Entry for negotiation of release or set

tlement. 35.14 Solicitation of legal business; negotia

tion of release or settlement; assistance

prohibited. 35.15 Consent to operative procedures. 35.16 Autopsies and other post-mortem op

erations. 35.17 Fees and charges for copying, certifi

cation, search of records and related Tervices.

Subpart E-Contributions for the Benefit of

Patients 35.61 Applicability. 35.62 Acceptance of contributions. 35.63 Report of and accounting for contribu

tions. 35.64 Donors. 35.65 Acceptable personal property. 35.66 Expenditure of cash contributions.

AUTHORITY: Sec. 215, 58 Stat. 690, as amended; 42 U.S.C. 216, sec. 321, 53 Stat. 695, as amended; 42 U.S.C. 248, unless otherwise noted.

SOURCE: 21 FR 9830, Dec. 12, 1966, unless otherwise noted.

Subpart A-General

8 35.1 Hospital and station rules.

The officer in charge of a station or hospital of the Service is authorized to adopt such rules and issue such instructions, not inconsistent with the regulations in this part and other provisions of law, as he deems necessary for the efficient operation of the station or hospital and for the proper and humane care and treatment of all patients therein. All general rules governing the conduct and privileges of patients, and of members of the public

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