Medical conditions of public health significance are categorized into those that preclude an immigrant or refugee from entering the United States class A or those that indicate a departure from normal well-being and for which follow-up after arrival is recommended class B.
An immigrant or refugee who has an inadmissible class A condition may still be issued a visa after the illness has been treated or after a waiver of the visa ineligibility has been approved by the Department of Homeland Security United States Citizenship and Immigration Services. CDC uses the medical screening examination reports and results collected at US ports of entry when immigrants and refugees arrive to notify state or local health departments of all arriving refugees and immigrants who have notifiable class A with waiver and class B conditions that require follow-up.
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State and local health departments are asked to report their findings back to CDC, and to provide information about any serious conditions of public health concern identified among recently arrived immigrants and refugees. Such reporting enables CDC to track epidemiologic patterns of disease in recently arrived immigrants and refugees and allows for monitoring of the quality of the overseas medical examinations.
A comprehensive new arrival health assessment is an additional opportunity to screen for communicable and noncommunicable diseases, to provide preventive services and individual counseling, to establish ongoing primary care and a medical home, and to orient new arrivals to the US health care system.
Immigrants and refugees often have other priorities related to their new environment, such as English classes, school, housing, and work, which may take precedence over accessing health care services.
Several organizations can facilitate health assessments for refugees such as the Association of Refugee Health Coordinators [ARHC] , and networks of clinicians who serve refugees and immigrants are growing. Ensure that migrants who are not recently arrived have completed the screenings associated with the new arrival health assessment, especially for diseases of long latency such as TB, hepatitis B, and HIV; if not, complete any missing tests.
It would also be ideal to be able to screen each person for diseases specific to his or her country of origin, migration route, and individual epidemiologic risk. Described below are guidelines available for the 2 populations for which there are the most data to guide screening efforts refugees and children adopted internationally , followed by an approach to performing health assessments for other categories of immigrants. The full guidelines and a summary checklist of the new arrival exam components and recommended testing are available at www.
CDC has also developed population-specific health profiles for certain populations e. A function of the new arrival health assessment is to arrange and coordinate ongoing primary care. Many refugees have not had age-appropriate screening for chronic diseases such as heart disease, diabetes, cancer, or hearing, vision, or dental problems; address these needs at early follow-up visits.
Several cancers are more prevalent in migrant populations, such as cervical, liver, stomach, and nasopharyngeal cancers. Introduce refugees to age-appropriate cancer screening tests, such as mammography, colonoscopy, and Papanicolaou tests during the new arrival exam. Integrate mental health screening into the new arrival health assessment, as it is an opportunity to screen for acute risk factors and triage refugees in need of urgent mental health treatment. Refugees determined ineligible for Medicaid are eligible for Refugee Medical Assistance in many states, which provides for their medical care needs for up to 8 months from their date of arrival.
For more information, clinicians and refugees can contact their state health departments and can access more information through the ORR, which administers this program www. This distinction is particularly pertinent for conditions that may continue to be infectious for weeks to months after arrival such as hepatitis A or B and giardiasis. Most families who adopt children internationally are required to have health insurance for the child effective upon arrival, so funding for the new arrival health assessment poses fewer problems than for other immigrant groups.
Newly arrived immigrants derive important benefits from their participation in a comprehensive new arrival health assessment and introduction to the US health system. Because immigrants enter the country in so many different ways, they access health care at multiple different points and with providers who have differing levels of expertise in immigrant medicine. There is no formal mechanism or funding source available to cover the costs of a standard comprehensive health assessment.
Immigrants may never receive any health assessment that targets conditions they may have acquired in their country of birth or during their migration process unless every health professional assumes the responsibility and has the knowledge to assess these issues when caring for patients born outside the United States.
Record all known medical and family history, and discuss medications and treatments received prior to migration. Most experts agree that testing for TB, hepatitis B, and HIV should be performed for all new arrivals to the United States who do not have documentation of prior screening. Obtain any records, laboratory evidence of immunity, and history of vaccine-preventable diseases; give, and age-appropriate vaccines be given as indicated. Vaccine series do not need to be restarted if documentation of prior doses is available.
Adding a basic mental health screening to the assessment including gathering information about coping strategies and support systems permits appropriate and timely referral to resources, if necessary. A complete blood count with differential for most new arrivals facilitates making a diagnosis of anemia or eosinophilia, or finding evidence of hemoglobinopathy. A urinalysis and basic metabolic panel may be indicated, especially for those of appropriate age or with evidence of conditions such as renal disease or diabetes.
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Consider diagnostic testing if an immigrant presents with symptoms consistent with a particular parasite endemic to their country of origin e. Travel medicine now includes groups who cross international boundaries into and out of the US, including immigrants documented and undocumented , refugees, asylum seekers, international adoptees, students, and corporate workers. Many clinics serving the traditional travel population also function as contact points within the US medical system for these populations, particularly for immigrants and refugees.
This section provides resources for clinicians and organizations that serve these populations to access up-to-date patient care guidelines, online education materials, and print resources. Skip directly to search Skip directly to A to Z list Skip directly to page options Skip directly to site content.
This document is intended to assist trans people in advocating for themselves with their healthcare providers and insurance companies. View the Document. These legal resources can help you navigate your name and gender change. Laws dictate how these processes take shape in each jurisdiction; therefore, processes do not look the same across jurisdictions. They are also subject to change.
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To ensure the process has not changed since that date, it is best to contact a local attorney. Please submit new resources below:. Box Asheville , NC Skip to primary navigation Skip to main content Download the Guide. Other state-level, regional, and national resource guides Resources for Funding Your Transition. ICD Insurance Codes for Transgender Health Care Time and again we hear from people who have been denied coverage of care related to their medical transition.
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