Authorizing Legislation Part II

Public Health Service, HHS

§ 34.2

to emergency measures necessary to
relieve pain.
(Sec. 610(b), 58 Stat. 714, as amended; 33
U.S.C. 763c)

PART 34—MEDICAL EXAMINATION
OF ALIENS
Sec.
34.1 Applicability.
34.2 Definitions.
34.3 Scope of examinations.
34.4 Medical notifications.
34.5 Postponement of medical examination.
34.6 Applicability of foreign quarantine regulations.
34.7 Medical and other care; death.
34.8 Reexamination; convening of review
boards; expert witnesses; reports.
AUTHORITY: 42 U.S.C. 252; 8 U.S.C. 1182 and
1222.
SOURCE: 81 FR 4201, Jan. 26, 2016, unless
otherwise noted.

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§ 34.1 Applicability.
The provisions of this part shall
apply to the medical examination of:
(a) Aliens applying for a visa at an
embassy or consulate of the United
States;
(b) Aliens arriving in the United
States;
(c) Aliens required by DHS to have a
medical examination in connection
with the determination of their admissibility into the United States; and
(d) Aliens applying for adjustment of
status.
§ 34.2 Definitions.
As used in this part, terms shall have
the following meanings:
(a) CDC. Centers for Disease Control
and Prevention, Department of Health
and Human Services, or an authorized
representative acting on its behalf.
(b) Communicable disease of public
health significance. Any of the following
diseases:
(1) Communicable diseases as listed
in a Presidential Executive Order, as
provided under Section 361(b) of the
Public Health Service Act. The current
revised list of quarantinable communicable diseases is available at http://
www.cdc.gov
and
http://
www.archives.gov/federal-register.
(2) Communicable diseases that may
pose a public health emergency of

international concern if it meets one or
more of the factors listed in § 34.3(d)
and for which the Director has determined a threat exists for importation
into the United States, and such disease may potentially affect the health
of the American public. The determination will be made consistent with criteria established in Annex 2 of the
International
Health
Regulations
(http://www.who.int/csr/ihr/en/), as adopted by the Fifty-Eighth World Health
Assembly in 2005, and as entered into
effect in the United States in July 2007,
subject to the U.S. Government’s reservation and understandings:
(i) Any of the communicable diseases
for which a single case requires notification to the World Health Organization (WHO) as an event that may constitute a public health emergency of
international concern, or
(ii) Any other communicable disease
the occurrence of which requires notification to the WHO as an event that
may constitute a public health emergency of international concern. HHS/
CDC’s determinations will be announced by notice in the FEDERAL REGISTER.
(3) Gonorrhea.
(4) Hansen’s disease, infectious.
(5) Syphilis, infectious.
(6) Tuberculosis, active.
(c) Civil surgeon. A physician designated by DHS to conduct medical examinations of aliens in the United
States who are applying for adjustment
of status to permanent residence or
who are required by DHS to have a
medical examination.
(d) Class A medical notification. Medical notification of:
(1) A communicable disease of public
health significance;
(2) A failure to present documentation of having received vaccination
against ‘‘vaccine-preventable diseases’’
for an alien who seeks admission as an
immigrant, or who seeks adjustment of
status to one lawfully admitted for permanent residence, which shall include
at least the following diseases: Mumps,
measles, rubella, polio, tetanus and
diphtheria
toxoids,
pertussis,
Haemophilus influenza type B and hepatitis B, and any other vaccinations recommended by the Advisory Committee
for Immunization Practices (ACIP) for

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§ 34.2

42 CFR Ch. I (10–1–22 Edition)

which HHS/CDC determines, by applying criteria published in the FEDERAL
REGISTER, there is a public health need
at the time of immigration or adjustment of status. Provided, however,
that in no case shall a Class A medical
notification be issued for an adopted
child who is 10 years of age or younger
if, prior to the admission of the child,
an adoptive parent or prospective adoptive parent of the child, who has sponsored the child for admission as an immediate relative, has executed an affidavit stating that the parent is aware
of the vaccination requirement and
will ensure that, within 30 days of the
child’s admission, or at the earliest
time that is medically appropriate, the
child will receive the vaccinations
identified in the requirement.
(3)(i) A current 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;
(ii) 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; or
(4) Drug abuse or addiction.
(e) Class B medical notification. Medical notification of a physical or mental health condition, disease, or disability serious in degree or permanent
in nature.
(f) DHS. U.S. Department of Homeland Security.
(g) Director. The Director of the Centers for Disease Control and Prevention
or a designee as approved by the Director or Secretary of Health and Human
Services.
(h) Drug abuse. ‘‘Current substance
use disorder or substance-induced disorder, mild’’ as defined in the most recent edition of the Diagnostic and Statistical Manual for Mental Disorders
(DSM) as published by the American
Psychiatric Association, or by another
authoritative source as determined by
the Director, of a substance listed in
Section 202 of the Controlled Substances Act, as amended (21 U.S.C. 802).
(i) Drug addiction. ‘‘Current substance
use disorder or substance-induced disorder, moderate or severe’’ as defined

in the most recent edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM), as published by
the American Psychiatric Association,
or by another authoritative source as
determined by the Director, of a substance listed in Section 202 of the Controlled Substances Act, as amended (21
U.S.C. 802).
(j) Medical examiner. A panel physician, civil surgeon, or other physician
designated by the Director to perform
medical examinations of aliens.
(k) Medical hold document. A document issued to DHS by a quarantine officer of HHS at a port of entry which
defers the inspection for admission
until the cause of the medical hold is
resolved.
(l) Medical notification. A medical examination document issued to a U.S.
consular authority or DHS by a medical examiner, certifying the presence
or absence of:
(1) A communicable disease of public
health significance;
(2) Documentation of having received
vaccination against ‘‘vaccine-preventable diseases’’ for an alien who seeks
admission as an immigrant, or who
seeks adjustment of status to one lawfully admitted for permanent residence, which shall include at least the
following diseases: Mumps, measles,
rubella, polio, tetanus and diphtheria
toxoids, pertussis, Haemophilus influenza type B and hepatitis B, and any
other vaccinations recommended by
the Advisory Committee for Immunization Practices (ACIP) for which HHS/
CDC determines, based upon criteria
published in the FEDERAL REGISTER,
there is a public health need at the
time of immigration or adjustment of
status. Provided, however, that in no
case shall a Class A medical notification be issued for an adopted child who
is 10 years of age or younger if, prior to
the admission of the child, an adoptive
parent or prospective adoptive parent
of the child, who has sponsored the
child for admission as an immediate
relative, has executed an affidavit stating that the parent is aware of the vaccination requirement and will ensure
that, within 30 days of the child’s admission, or at the earliest time that is
medically appropriate, the child will

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§ 34.3

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receive the vaccinations identified in
the requirement;
(3)(i) A current 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;
(ii) 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;
(4) Drug abuse or addiction; or
(5) Any other physical or mental condition, disease, or disability serious in
degree or permanent in nature.
(m) Medical officer. A physician or
other medical professional assigned by
the Director to conduct physical and
mental examinations of aliens on behalf of HHS/CDC.
(n) Mental disorder. A currently accepted psychiatric diagnosis, as defined
by the current edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association or by another authoritative source as determined by the Director.
(o) Panel physician. A physician selected by a United States embassy or
consulate to conduct medical examinations of aliens applying for visas.
(p) Physical disorder. A currently accepted medical diagnosis, as defined by
the current edition of the Manual of
the International Classification of Diseases, Injuries, and Causes of Death
published by the World Health Organization or by another authoritative
source as determined by the Director.
§ 34.3 Scope of examinations.
(a) General. In performing examinations, medical examiners shall consider
those matters that relate to the following:
(1) Communicable disease of public
health significance;
(2) Documentation of having received
vaccination against ‘‘vaccine-preventable diseases’’ for an alien who seeks
admission as an immigrant, or who
seeks adjustment of status to one lawfully admitted for permanent residence, which shall include at least the
following diseases: Mumps, measles,

rubella, polio, tetanus and diphtheria
toxoids, pertussis, Haemophilus influenza type B and hepatitis B, and any
other vaccinations recommended by
the Advisory Committee for Immunization Practices (ACIP) for which HHS/
CDC determines there is a public
health need at the time of immigration
or adjustment of status.
Provided, however, that in no case
shall a Class A medical notification be
issued for an adopted child who is 10
years of age or younger if, prior to the
admission of the child, an adoptive parent or prospective adoptive parent of
the child, who has sponsored the child
for admission as an immediate relative, has executed an affidavit stating
that the parent is aware of the vaccination requirement and will ensure that,
within 30 days of the child’s admission,
or at the earliest time that is medically appropriate, the child will receive
the vaccinations identified in the requirement;
(3)(i) A current 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;
(ii) 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;
(4) Drug abuse or drug addiction; and
(5) Any other physical or mental
health condition, disease, or disability
serious in degree or permanent in nature.
(b) Scope of all medical examinations.
(1) All medical examinations will include the following:
(i) A general physical examination
and medical history, evaluation for tuberculosis, and serologic testing for
syphilis.
(ii) A physical examination and medical history for diseases specified in
§§ 34.2(b)(1), and 34.2(b)(4) through
34.2(b)(10).
(2) For the examining physician to
reach a determination and conclusion
about the presence or absence of a
physical or mental abnormality, disease, or disability, the scope of the examination shall include any laboratory

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§ 34.3

42 CFR Ch. I (10–1–22 Edition)

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 or other relevant
records.
(c) Additional medical screening and
testing for examinations performed
outside the United States.
(1) HHS/CDC may require additional
medical screening and testing for medical examinations performed outside
the United States for diseases specified
in §§ 34.2(b)(2) and 34.2(b)(3) by applying
the risk-based medical and epidemiologic factors in paragraph (d)(2) of this
section.
(2) Such examinations shall be conducted in a defined population in a geographic region or area outside the
United States as determined by HHS/
CDC.
(3) Additional medical screening and
testing shall include a medical interview, physical examination, laboratory
testing, radiologic exam, or other diagnostic procedure, as determined by
HHS/CDC.
(4) Additional medical screening and
testing will continue until HHS/CDC
determines such screening and testing
is no longer warranted based on factors
such as the following: Results of disease outbreak investigations and response efforts; effectiveness of containment and control measures; and the
status of an applicable determination
of public health emergency of international concern declared by the Director General of the WHO.
(5) HHS/CDC will directly provide
medical examiners information pertaining to all applicable additional requirements for medical screening and
testing, and will post these at the following
Internet
addresses:
http://
www.cdc.gov/ncidod/dq/technica.htm and
http://www.globalhealth.gov.
(d) Risk-based approach. (1) HHS/CDC
will use the medical and epidemiological factors listed in paragraph (d)(2) of
this section to determine the following:
(i) Whether a disease as specified in
§ 34.2(b)(3)(ii) is a communicable disease
of public health significance;
(ii) Which diseases in § 34.2(b)(2) and
(3) merit additional screening and testing, and the geographic area in which
HHS/CDC will require this screening.

(2) Medical and epidemiological factors include the following: (i) The seriousness of the disease’s public health
impact;
(ii) Whether the emergence of the
disease was unusual or unexpected;
(iii) The risk of the spread of the disease in the United States;
(iv)
The
transmissibility
and
virulence of the disease;
(v) The impact of the disease at the
geographic location of medical screening; and
(vi) Other specific pathogenic factors
that would bear on a disease’s ability
to threaten the health security of the
United States.
(e) Persons subject to requirement for
chest radiograph examination and serologic testing. (1) As provided in paragraph (e)(2) of this section, a chest
radiograph examination and serologic
testing for syphilis shall be required as
part of the examination of the following:
(i) Applicants for immigrant visas;
(ii) Students, exchange visitors, and
other applicants for non-immigrant
visas required by a U.S. consular authority to have a medical examination;
(iii) Applicants outside the United
States who apply for refugee status;
(iv) Applicants in the United States
who apply for adjustment of their status under the immigration statute and
regulations.
(v) Applicants required by DHS to
have a medical examination in connection with determination of their admissibility into the United States.
(2) Chest radiograph examination and
serologic testing. Except as provided in
paragraph (e)(2)(iv) of this section, applicants described in paragraph (e)(1) of
this section shall be required to have
the following:
(i) For applicants 15 years of age and
older, a chest radiograph examination;
(ii) For applicants under 15 years of
age, a chest radiograph examination if
the applicant has symptoms of tuberculosis, a history of tuberculosis, or
evidence of possible exposure to a
transmissible tuberculosis case in a
household or other enclosed environment for a prolonged period;
(iii) For applicants 15 years of age
and older, serologic testing for syphilis

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Public Health Service, HHS

§ 34.3

and other communicable diseases of public health significance as determined by
the Director through technical instructions.
(iv) Exceptions. Serologic testing for
syphilis shall not be required if the
alien is under the age of 15, unless
there is reason to suspect infection
with syphilis. An alien, regardless of
age, in the United States, who applies
for adjustment of status to lawful permanent resident, shall not be required
to have a chest radiograph examination unless their tuberculin skin test,
or an equivalent test for showing an
immune response to Mycobacterium tuberculosis antigens, is positive. HHS/
CDC may authorize exceptions to the
requirement for a tuberculin skin test,
an equivalent test for showing an immune response to Mycobacterium tuberculosis antigens, or chest radiograph
examination for good cause, upon application approved by the Director.
(3) Immune response to Mycobacterium
tuberculosis antigens. (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 DHS to have a medical
examination in connection with a determination of their admissibility,
shall be required to have a tuberculin
skin test or an equivalent test for
showing an immune response to
Mycobacterium tuberculosis antigens.
Exceptions to this requirement may be
authorized for good cause upon application approved by the Director. In the
event of a positive test of immune response, a chest radiograph 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 in the United States less
than 2 years of age shall be required to
have a tuberculin skin test, or an
equivalent, appropriate test to show an
immune response to Mycobacterium tuberculosis antigens, 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

test of immune response, a chest
radiograph 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.
(iii) Aliens outside the United States
required to have a medical examination shall be required to have a tuberculin skin test, or an equivalent, appropriate test to show an immune response to Mycobacterium tuberculosis
antigens, and, if indicated, a chest
radiograph.
(iv) Aliens outside the United States
required to have a medical examination shall be required to have a tuberculin skin test, or an equivalent, appropriate test to show an immune response to Mycobacterium tuberculosis
antigens, and a chest radiograph, regardless of age, if he/she has symptoms
of tuberculosis, a history of tuberculosis, or evidence of possible exposure to a transmissible tuberculosis
case in a household or other enclosed
environment for a prolonged period, as
determined by the Director.
(4) Additional testing requirements. All
applicants may be required to undergo
additional testing for tuberculosis
based on the medical evaluation.
(5) How and where performed. All
chest radiograph images used in medical examinations performed under the
regulations to this part shall be large
enough to encompass the entire chest.
(6) Chest x-ray, laboratory, and treatment reports. The chest radiograph
reading and serologic test results for
syphilis 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
image, the medical notification shall
include at least a summary statement
of findings of the earlier images, followed by a complete reading of the last
image, and dates and details of any laboratory tests and treatment for tuberculosis.
(f) Procedure for transmitting records.
For aliens issued immigrant visas, the
medical
notification
and
chest
radiograph images, if any, shall be
placed in a separate envelope, which

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42 CFR Ch. I (10–1–22 Edition)

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shall be sealed. When more than one
chest radiograph image is used as a
basis for the examiner’s conclusions,
all images shall be included. Records
may be transmitted by other means, as
approved by the Director.
(g) 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
examination procedures. A medical
hold document may be issued for aliens
who:
(1) Are not in possession of a valid
medical notification, if required;
(2) Have a medical notification which
is incomplete;
(3) Have a medical notification which
is not written in English;
(4) Are suspected to have an inadmissible medical condition.
(h) The Secretary of Homeland Security, after consultation with the Secretary of State and the Secretary of
Health and Human Services, may in
emergency circumstances permit the
medical examination of refugees to be
completed in the United States.
(i) All medical examinations shall be
carried out in accordance with such
technical instructions for physicians
conducting the medical examination of
aliens as may be issued by the Director. Copies of such technical instructions are available upon request to the
Director, Division of Global Migration
and Quarantine, Mailstop E03, HHS/
CDC, Atlanta GA 30333.
§ 34.4 Medical notifications.
(a) Medical examiners shall issue
medical notifications of their findings
of the presence or absence of Class A or
Class B medical conditions. The presence of such condition must have been
clearly established.
(b) Class A medical notifications. (1)
The medical examiner shall report his/
her findings to the consular officer or
DHS by Class A medical notification
which lists the specific condition for
which the alien may be inadmissible, if
an alien is found to have:
(i) A communicable disease of public
health significance;
(ii) A lack of documentation, or no
waiver, for an alien who seeks admission as an immigrant, or who seeks ad-

justment of status to one lawfully admitted for permanent residence, of
having received vaccination against
vaccine-preventable
diseases
which
shall include at least the following diseases: Mumps, measles, rubella, polio,
tetanus and diphtheria toxoids, pertussis, Haemophilus influenza type B
and hepatitis B, and any other vaccinations recommended by the Advisory
Committee for Immunization Practices
(ACIP) for which HHS/CDC determines,
by applying criteria published in the
FEDERAL REGISTER, there is a public
health need at the time of immigration
or adjustment of status. Provided however, that a Class A medical notification shall in no case be issued for an
adopted child who is 10 years of age or
younger if, prior to the admission of
the child, an adoptive parent or prospective adoptive parent of the child,
who has sponsored the child for admission as an immediate relative, has executed an affidavit stating that the parent is aware of the vaccination requirement and will ensure that, within 30
days of the child’s admission, or at the
earliest time that is medically appropriate, the child will receive the vaccinations identified in the requirement;
(iii)(A) A current 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;
(iv) Drug abuse or drug addiction.
Provided, however, that a Class A medical notification of a physical or mental disorder, and behavior associated
with that disorder that may pose, or
has posed, a threat to the property,
safety, or welfare of the alien or others, shall in no case be issued with respect to an alien having only mental
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.

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(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.
(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 DHS officer
by Class B medical notification which
lists the specific conditions found by
the medical examiner. Provided, however, that a Class B medical notification shall in no case be issued with respect to an alien having only mental
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
DHS officer.
§ 34.5 Postponement of medical examination.
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.
§ 34.6 Applicability of
antine regulations.

foreign

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.
§ 34.7

Medical and other care; death.

(a) An alien detained by or in the
custody of DHS may be provided medical, surgical, psychiatric, or dental
care by HHS through interagency
agreements under which DHS shall reimburse HHS. 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 DHS 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 DHS and subject to its agreement to pay the burial
expenses. Autopsies shall not be performed unless approved by DHS.
§ 34.8 Reexamination; convening of review boards; expert witnesses; reports.
(a) The Director shall convene a
board of medical officers to reexamine
an alien:
(1) Upon the request of DHS for a reexamination by such a board; or
(2) Upon an appeal to DHS by an
alien who, having received a medical
examination in connection with the determination of admissibility to the
United States (including examination
on arrival and adjustment of status as
provided in the immigration laws and
regulations) has been certified for a
Class A condition.

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§ 34.8

42 CFR Ch. I (10–1–22 Edition)

(b) The board shall reexamine an
alien certified as:
(1) Having a communicable disease of
public health significance;
(2) Lacking documentation of having
received vaccination against ‘‘vaccinepreventable diseases’’ for an alien who
seeks admission as an immigrant, or
who seeks adjustment of status to one
lawfully admitted for permanent residence, which shall include at least the
following diseases: Mumps, measles,
rubella, polio, tetanus and diphtheria
toxoids, pertussis, Haemophilus influenza type B and hepatitis B, and any
other vaccinations recommended by
the Advisory Committee for Immunization Practices (ACIP) for which HHS/
CDC determines, by applying criteria
published in the FEDERAL REGISTER,
there is a public health need at the
time of immigration or adjustment of
status. Provided, however, that in no
case shall a Class A medical notification be issued for an adopted child who
is 10 years of age or younger if, prior to
the admission of the child, an adoptive
or prospective adoptive parent, who
has sponsored the child for admission
as an immediate relative, has executed
an affidavit stating that the parent is
aware of the vaccination requirement
and will ensure that the child will be
vaccinated within 30 days of the child’s
admission, or at the earliest time that
is medically appropriate.
(3)(i) Having a current 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
(ii) Having 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; or
(iii) Having drug abuse or drug addiction;
(c) The board shall consist of the following:
(1) In circumstances covered by paragraph (b)(1) of this section, the board
shall consist of at least one medical officer who is experienced in the diagnosis and treatment of the commu-

nicable disease for which the medical
notification has been made;
(2) In circumstances covered by paragraph (b)(2) of this section, the board
shall consist of at least one medical officer who is experienced in the diagnosis and treatment of the vaccine-preventable disease for which the medical
notification has been made;
(3) In circumstances covered by paragraph (b)(3) of this section, the board
shall consist of at least one medical officer who is experienced in the diagnosis and treatment of the physical or
mental disorder, or substance-related
disorder for which medical notification
has been made.
(d) The decision of the majority of
the board shall prevail, provided that
at least two medical officers concur in
the judgment of the board.
(e) Reexamination shall include:
(1) Review of all records submitted by
the alien, other witnesses, or the
board;
(2) Use of any laboratory or additional studies which are deemed clinically necessary as a result of the physical examination or pertinent information elicited from the alien’s medical
history;
(3) Consideration of statements regarding the alien’s physical or mental
condition made by a physician after
his/her examination of the alien; and
(4) A physical or psychiatric examination of the alien performed by the
board, at the board’s discretion;
(f) An alien who is to be reexamined
shall be notified of the reexamination
not less than 5 days prior thereto.
(g) The alien, at his/her own cost and
expense, may introduce as witnesses
before the board such physicians or
medical experts as the board may in its
discretion permit; provided that the
alien shall be permitted to introduce at
least one expert medical witness. If any
witnesses offered are not permitted by
the board to testify (either orally or
through written testimony), the record
of the proceedings shall show the reason for the denial of permission.
(h) Witnesses before the board shall
be given a reasonable opportunity to
review the medical notification and
other records involved in the reexamination and to present all relevant and
material evidence orally or in writing

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Public Health Service, HHS

Pt. 35

until such time as the reexamination is
declared by the board to be closed. During the course of the reexamination the
alien’s attorney or representative shall
be permitted to question the alien and
he/she, or the alien, shall be permitted
to question any witnesses offered in
the alien’s behalf or any witnesses
called by the board. If the alien does
not have an attorney or representative,
the board shall assist the alien in the
presentation of his/her case to the end
that all of the material and relevant
facts may be considered.
(i) Any proceedings under this section may, at the board’s discretion, be
conducted based on the written record,
including through written questions
and testimony.
(j) The findings and conclusions of
the board shall be based on its medical
examination of the alien, if any, and on
the evidence presented and made a part
of the record of its proceedings.
(k) The board shall report its findings
and conclusions to DHS, and shall also
give prompt notice thereof to the alien
if his/her reexamination has been based
on his/her appeal. The board’s report to
DHS shall specifically affirm, modify,
or reject the findings and conclusions
of prior examining medical officers.
(l) The board shall issue its medical
notification in accordance with the applicable provisions of this part if it
finds that an alien it has reexamined
has a Class A or Class B condition.
(m) If the board finds that an alien it
has reexamined does not have a Class A
or Class B condition, it shall issue its
medical notification in accordance
with the applicable provisions of this
part.
(n) After submission of its report, the
board shall not be reconvened, nor
shall a new board be convened, in connection with the same application for
admission or for adjustment of status,
except upon the express authorization
of the Director.

PART 35—HOSPITAL AND STATION
MANAGEMENT
jspears on DSK121TN23PROD with CFR

Subpart A—General
Sec.
35.1 Hospital and station rules.
35.2 Compliance with hospital rules.

35.3

Noncompliance; deprivation of privileges.
35.4 Noncompliance; discharge or transfer.
35.5 Entitlement to care after discharge or
transfer by reason of noncompliance.
35.6 Admissions; determination of eligibility for care.
35.7 Admissions; designation of person to be
notified.
35.8 Safekeeping of money and effects; withdrawals.
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 prohibited.
35.13 Entry for negotiation of release or settlement.
35.14 Solicitation of legal business; negotiation of release or settlement; assistance
prohibited.
35.15 Consent to operative procedures.
35.16 Autopsies and other post-mortem operations.
35.17 Fees and charges for copying, certification, search of records and related
services.

Subpart B—Transfer of Patients
35.21
35.22

Authorization of transfer.
Attendants.

Subpart C—Disposition of Articles
Produced by Patients
35.31
35.32
35.33
35.34
35.35

Retention by patients.
Board of appraisers.
Sale; prices; deposit of proceeds.
Resale.
Unsalable articles.

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 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.

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