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p) Physical disorder. A currently acted medical diagnosis, as defined by Manual of the International ClassiScation of Diseases, Injuries, and ruses of Death published by the World alth Organization, or by other auoritative sources.

De FR 9829, Dec. 12, 1956, as amended at 52 32543, Aug. 28, 1987; 56 FR 25001, May 31, [1]

34.3 Scope of examinations.

(a) General. In performing examinadons, medical examiners shall consider ose matters that relate to:

(1) A communicable disease of public ealth significance;

(2)(i) A physical or mental disorder nd behavior associated with the disrder that may pose, or has posed, a hreat to the property, safety, or welare of the alien or others;

(ii) A history of a physical or mental isorder and behavior associated with he disorder, which behavior has posed

threat to the property, safety, or welSare of the alien or others and which Dehavior is likely to recur or lead to bother harmful behavior;

(3) Drug abuse or addiction; and

(4) Any other physical abnormality, disease, or disability serious in degree dor 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:

(i) 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 radiogranh is consistent with tuberculosi shall be referred to the loca thority for evaluation F evaluation shall

civil surgeon before a medical notification may be issued.

(3) Sputum smear examination. All aliens subject to the chest X-ray examination requirement and for whom the radiograph shows an abnormality consistent with pulmonary tuberculosis shall be required to have a sputum smear examination for acid-fast bacilli. (4) How and where performed. All chest X-ray films used in medical examinations performed under the regulations in this part shall be large enough to encompass the entire chest (approximately 14 by 17 inches; 35.6×43.2 cm.). Serologic testing for HIV shall be a sensitive and specific test, confirmed when positive by a test such as the Western blot test or an equally reliable test. 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 serologic testing of refugees for HIV to be completed in the United States.

(5) Chest X-ray, laboratory, and treatment reports. The chest X-ray reading and serologic test results for syphilis and HIV shall be included in the medical notification. When the medical examiner's conclusions are based on a study of more than one chest X-ray film, the medical notification shall include at least a summary statement of findings of the earlier films, followed by a complete reading of the last film, and dates and details of any laboratory tests and treatment for tuberculosis.

(c) Procedure for transmitting records. For aliens issued immigrant visas, the medical notification and chest X-ray film, if any, 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 at the U.S. port of entry. When more than one chest X-ray film is used as a basis for the examiner's conclusions, all films shall be included.

(d) Failure to present records. When a determination of admissibility is to be made at the U.S. port of entry, a medical hold document shall be issued pending completion of any necessary exam

ination procedures. A medical i document may be issued for aliens

(1) Are not in possession of a m medical notification, if required; (2) Have a medical notification w is incomplete;

(3) Have a medical notification wis is not written in English;

(4) Are suspected to have an excis able medical condition.

(e) The Attorney General, after sultation with the Secretary of St and the Secretary of Health Human Services, may in emerges circumstances permit the medical e amination of refugees to be complex in the United States.

(f) All medical examinations shall carried out in accordance with technical instructions for physic conducting the medical examination: aliens as may be issued by the Dira tor. Copies of such technical instru tions are available upon request to th Director, Division of Quarantine Mailstop E03, CDC, Atlanta GA 30333. [56 FR 25002, May 31, 1991]

§ 34.4 Medical notifications.

(a) Medical examiners shall issu medical notifications of their finding of the presence or absence of Class A Class B medical conditions. The pres ence of such condition must have bee clearly established.

(b) Class A medical notifications. (1 The medical examiner shall report his her findings to the consular officer of the INS by Class A medical notifica tion which lists the specific condition for which the alien may be excluded, i' an alien is found to have:

(i) A communicable disease of public health significance;

(ii)(A) A physical or mental disorder. and behavior associated with the disorder that may pose, or has posed, a threat to the property, safety, or welfare of the alien or others; or

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

(iii) Drug abuse or addition. Provided, however, That a Class A medical notification of a physical or mental

sorder, and behavior associated with at disorder that may pose, or has sed, a threat to the property, safety, welfare of the alien or others, shall no case be issued with respect to an ien having only mental shortcomings le to ignorance, or suffering only om a condition attributable to remeiable physical causes or of a temorary nature, caused by a toxin, medially prescribed drug, or disease.

(2) The medical notification shall tate the nature and extent of the abFormality; the degree to which the alien is incapable of normal physical .ctivity; and the extent to which the ondition is remediable. The medical xaminer shall indicate the likelihood, hat because of the condition, the applicant will require extensive medical Sare or institutionalization.

(c) Class B medical notifications. (1) If an alien is found to have a physical or mental abnormality, disease, or disability serious in degree or permanent in nature amounting to a substantial departure from normal well-being, the medical examiner shall report his/her findings to the consular or INS officer by Class B medical notification which lists the specific conditions found by the medical examiner. Provided, however, that a Class B medical notifica#tion shall in no case be issued with respect to an alien having only mental 4 shortcomings due to ignorance, or suffering only from a condition attributable to remediable physical causes or of a temporary nature, caused by a toxin, medically prescribed drug, or disease.

(2) The medical notification shall state the nature and extent of the abnormality, the degree to which the alien is incapable of normal physical activity, and the extent to which the condition is remediable. The medical examiner shall indicate the likelihood, that because of the condition, the applicant will require extensive medical care or institutionalization.

(d) Other medical notifications. If as a result of the medical examination, the medical examiner does not find a Class A or Class B condition in an alien, the medical examiner shall so indicate on the medical notification form and shall

report his findings to the consular or INS officer.

[56 FR 25003, May 31, 1991]

$34.5 Postponement of medical exam

ination.

Whenever, upon an examination, the medical examiner is unable to determine the physical or mental condition of an alien, completion of the medical examination shall be postponed for such observation and further examination of the alien as may be reasonably necessary to determine his/her physical or mental condition. The examination shall be postponed for aliens who have an acute infectious disease until the condition is resolved. The alien shall be referred for medical care as necessary.

[56 FR 25003, May 31, 1991]

$34.6 Applicability of Foreign Quarantine Regulations.

Aliens arriving at a port of the United States shall be subject to the applicable provisions of 42 CFR part 71, Foreign Quarantine, with respect to examination and quarantine measures.

[56 FR 25003, May 31, 1991]

§ 34.7 Medical and other care; death.

(a) An alien detained by or in the custody of the INS may be provided medical, surgical, psychiatric, or dental care by the Public Health Service through interagency agreements under which the INS shall reimburse the Public Health Service. Aliens found to be in need of emergency care in the course of medical examination shall be treated to the extent deemed practical by the attending physician and if considered to be in need of further care, may be referred to the INS along with the physician's recommendations concerning such further care.

(b) In case of the death of an alien, the body shall be delivered to the consular or immigration authority concerned. If such death occurs in the United States, or in a territory or possession thereof, public burial shall be provided upon request of the INS and subject to its agreement to pay the

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Inventory.

35.41 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 proceeds.

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 unaffected.

Subpart E-Contributions for the Benefit of

Patients

35.61 Applicability.

35.62 Acceptance of contributions.

35.63 Report of and accounting for contributions.

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, 1956, unless otherwise noted.

Subpart A-General

§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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