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Medical Examinations FAQs

General questions, are children required to have chest x-rays or blood tests.

Chest X-ray and blood tests are not usually required for children under the age of fifteen.

What if the applicant has an intellectual or learning disability?

Applicants with an intellectual or learning disability must present a report of their condition and any special educational or supervision requirements.

What is the legal basis for requesting medical information for visa applicants?

Medical eligibility is a requirement of INA Sections 212(a) and 221(d). Failure to provide required information may cause delay or denial of immigrant visas. If an immigrant visa is not issued, all medical eligibility forms will be treated as confidential under INA Section 222(f).

What should the applicant expect at the medical examination

The applicant must show his/her passport (or other photo identification) and appointment letter to the doctor during the medical examination.

The medical examination will include a medical history review, physical examination, chest X-ray and blood tests for syphilis.

The physical examination will at least include examination of the eyes, ears, nose and throat, extremities, heart, lungs, abdomen, lymph nodes and skin.

In some countries, the panel physician will send the results to the U.S. Embassy/Consulate directly. In other countries, the panel physician will give the applicant his/her medical exam results in a sealed envelope and an x-ray which the applicant must bring to the interview.

Note:   The medical examination is not a complete physical examination. Its purpose is to screen for certain medical conditions relevant to U.S. immigration law. The panel physician is not required to examine you for any conditions except those the U.S. Public Health Service specifies for U.S. immigration purposes, nor is the physician required to provide you with diagnosis or treatment even though other matters related to your health might be discovered. This examination is not a substitute for a full physical examination, consultation, diagnosis, or treatment by your primary health care provider.

Medical Conditions/History

What if the applicant had a positive tuberculosis skin test.

Applicants with a previous positive skin test for tuberculosis should provide a certificate from the attending doctor (giving the circumstances of the positive test result, and indicating any treatment prescribed, and its duration) to the panel physician. If the applicant has ever been diagnosed with tuberculosis, the applicant must present a written certification, signed by the attending doctor, proving that the applicant was adequately treated. The certificate must include dates and types of medications taken. Applicants who ever had an abnormal chest X-ray should borrow the last X-ray films taken and bring them to the panel physician. The actual films, not the typed reports, may be required to compare with the X-rays that will be taken at the medical examination.

What if the applicant had syphilis?

Applicants who have had syphilis must present the panel doctor with a written certificate, signed by a doctor or public health official, proving that the applicant was adequately treated. Applicants who ever had a positive VDRL or other blood test for syphilis, and were not treated must give a written explanation signed by the applicant’s doctor to the panel physician.

If the applicant is pregnant must she have a chest x-ray?

The U.S. Centers for Disease Control and Prevention (CDC) requires that women who are pregnant and required to have a medical examination in connection with the issuance of a visa, and are examined in a country currently using the 2007 TB Technical Instructions must have a chest x-ray examination conducted. Pregnant women will have to provide the panel physician with consent to conduct the chest x-ray. For the health of the applicant and her unborn child, CDC instructs panel physicians and laboratories to provide abdominal and pelvic protection with double layer, wrap-around lead shields when they receive the chest radiographs. 

What if the applicant has a history of harmful or violent behavior?

Applicants with any history of harmful or violent behavior resulting in injury to people or animals, or harm to inanimate objects must provide information that will allow the panel physician to determine if the behavior was related to a psychiatric or medical problem, or to drug or alcohol use. Harmful behavior includes attempted suicide or self-harm, no matter how minor in nature.

What if the applicant has been treated or hospitalized for psychiatric or mental illness, or alcohol or drug abuse?

Applicants treated or hospitalized for psychiatric or mental illness or alcohol or drug abuse must present written certification including the diagnosis, duration of treatment rendered, and prognosis.

What if the applicant is being treated for a chronic medical condition or is taking medication on a regular basis?

Applicants being treated for chronic medical conditions, or those taking medications on a regular basis, should be familiar with the medical conditions being treated, and the names of the medications they are taking. Applicants unsure of their diagnoses must present a certificate describing the condition(s), the current treatment, and prognosis with a list of prescribed medications.

Can the applicant have a medical examination if she is having her menstrual period?

Yes, the applicant may have the examination even if she is having her menstrual period.

Can the applicant have his/her physician perform the medical examination?

The medical examination must be performed by an approved panel physician.

Can the medical examination take place in the United States if the applicant is pursuing a visa application abroad while physically present in the United States?

Visa medical examinations may not be conducted in the United States. An alien pursuing a visa application abroad while physically present in the United States must have the medical examination conducted by a panel physician approved by the visa issuing U.S. Embassy/Consulate.

Vaccinations

What vaccinations are required.

The following vaccinations are required for immigration purposes:

• Hepatitis A
• Hepatitis B
• Influenza type b (Hib)
• Meningococcal
• Pneumococcal
• Tetanus and diphtheria toxoids

For the Panel Physician Technical Instructions relating to the vaccination requirements, please visit the  Centers for Disease Control and Prevention  website.

What do I do if the applicant does not have a vaccination record?

The panel physician will work with the applicant to determine which vaccinations the applicant may need to meet vaccination requirements.

What if there is a medical reason for the applicant to not receive a listed vaccination?

Certain waivers of the vaccination requirement are available upon the recommendation of the panel physician.

Who's Involved

U.S. Embassies and Consulates:  Find a  U.S. Embassy or Consulate , nearest your residence abroad, where you will apply and be interviewed for your U.S. visa.

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Who needs a TB test for their visa application?

To prevent the spread of Tuberculosis (TB), many countries, including the UK, have implemented TB screening and testing measures for visa applicants. In this blog, we will explore the TB test requirement for UK visa applications, helping you determine whether you need to undergo this medical examination as part of your visa process.

Who needs a tb test for their uk visa application.

Not all UK visa applicants are required to undergo a TB test. The necessity of this test depends on several factors, including your visa type and home country, or the countries you have recently visited. Here are the key criteria to determine whether you need a TB test for your UK visa application:

Visa Type: The type of UK visa you are applying for plays a significant role in whether or not you need a TB test. Typically, individuals applying for a UK visa that involves a stay of more than six months and who are coming from countries with a high incidence of TB are more likely to require a TB test. Such visas may include student visas, work visas, and family visas.

Home Country or Recent Travel History: The requirement for a TB test is often linked to your country of residence or recent travel history. If you are a citizen or resident of a country with a high TB incidence, you are more likely to be asked to undergo the test. You can find a list here.

Exemptions: Some categories of applicants are exempt from the TB test requirement. You will not need a TB test if any of the following apply:

• you’re a diplomat accredited to the UK
• you’re a returning UK resident and have not been away for more than 2 years
• you have lived in a country where TB screening is not required by the UK for at least 6 months, and you’ve been away from that country for no more than 6 months

Obtain a Certificate: If the test results are negative, you will receive a certificate indicating that you are free from active TB. This certificate is a crucial document for your visa application. You will need to include the TB test certificate with your visa application to demonstrate compliance with the UK’s health  screening requirements.

How Gherson can assist

Gherson’s Immigration Team are highly experienced in advising on UK visa matters. If you have any questions arising from this blog, please do not hesitate to  contact us  for advice, send us an  e-mail , or, alternatively, follow us on  Twitter ,  Facebook ,  In stagram , or  LinkedIn  to stay-up-to-date.

The information in this blog is for general information purposes only and does not purport to be comprehensive or to provide legal advice. Whilst every effort is made to ensure the information and law is current as of the date of publication it should be stressed that, due to the passage of time, this does not necessarily reflect the present legal position. Gherson accepts no responsibility for loss which may arise from accessing or reliance on information contained in this blog. For formal advice on the current law please do not hesitate to contact Gherson. Legal advice is only provided pursuant to a written agreement, identified as such, and signed by the client and by or on behalf of Gherson.

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• Section 5 - Tuberculosis
• Section 5 - Typhoid & Paratyphoid Fever

Perspectives : Testing Travelers for Mycobacterium Tuberculosis Infection

Cdc yellow book 2024.

Author(s): John Jereb

Screening for asymptomatic Mycobacterium tuberculosis infections should only be carried out for travelers at risk of acquiring tuberculosis (TB) at their destinations (see Sec. 5, Part 1, Ch. 22, Tuberculosis ). Screening with a tuberculin skin test (TST) or interferon-γ release assay (IGRA) in very-low-risk travelers might produce false-positive test results, leading to unnecessary additional screening or treatment. IGRAs, which require a single blood draw, are approximately as specific as TST in people who have not been vaccinated with bacillus Calmette-Guérin (BCG) and are more specific in BCG-vaccinated populations. Moreover, TST is prone to boosting sensitivity in serial testing, necessitating a 2-step initial test for establishing a baseline, which is unneeded with IGRAs. Using screening tests in very-low-prevalence populations will probably produce more false positives than true positives.

Travelers at risk for TB infection include those going to live in a TB-endemic country or anyone intending to spend any length of time in routine contact with patients in health care facilities or populations living in congregate settings (e.g., homeless shelters, prisons, refugee camps). People at low risk for exposure to TB, which includes most travelers, do not need to be screened before or after travel.

For travelers who anticipate a long stay or contact with a high-risk population, perform pretravel screening by using an IGRA or, when IGRA is not available, 2-step TST screening. CDC guidelines recommend testing with an IGRA (as opposed to TST) for people aged ≥5 years in low-risk populations. The American Academy of Pediatrics guidelines recommend an IGRA for children ≥2 years old; some pediatric TB experts use IGRAs for all children. If an IGRA is used for pretravel testing and there is concern for a false positive in an otherwise low-risk traveler, a second test can be used, which confirms TB infection only if both tests are positive. If the IGRA result is negative, repeat the traveler’s test 8–10 weeks after they return from their trip; however, data supporting a recommendation for regular serial testing for a long-term traveler are limited.

If TST is used for pretravel testing, use the 2-step TST for any traveler undergoing TST testing for the first time. The 2-step method is not needed for travelers who have already been tested and found to have a negative result within the previous 2 years. For the 2-step method, anyone whose baseline TST yields a negative result should be retested 1–3 weeks after the initial test; if the second test result is negative, the patient can be considered not infected. If the second test result is positive, the patient is classified as having skin test boosting, possibly because of previous M. tuberculosis infection.

The 2-step TST is recommended over single TST in this population because some people infected with M. tuberculosis years earlier (or who were sensitized by BCG or nontuberculous mycobacteria) exhibit waning delayed-type hypersensitivity to tuberculin. When skin tested years after infection, these people might have a negative initial TST result even though they had been sensitized previously. The first TST might stimulate the ability to react to subsequent tests, however, resulting in a “booster” reaction. When the test gets repeated at some future date, a positive result could be misinterpreted as a new M. tuberculosis infection (recent conversion) rather than a boosted reaction. For travelers who do not have enough time to complete a 2-step TST before departure, a single-step TST is an acceptable alternative, but an IGRA is preferred.

If the result of a pretravel test (either IGRA or 2-step TST) for M. tuberculosis infection is negative, a traveler should have a posttravel test with the same type of test used pretravel, 8–10 weeks after returning from their trip. People who have repeat TSTs should be tested with the same tuberculin purified protein derivative solution, because switching products can lead to different test results. The US Food and Drug Administration has approved 2 commercially available tuberculin solutions for skin testing: Aplisol (JHP Pharmaceuticals) and Tubersol (Sanofi Pasteur). During extended (>6 months) stays in, or repeated travel to, high-risk settings, travelers should have repeat testing every 6–12 months while traveling outside the United States and then 8–10 weeks after final return, all with the same type of test used pretravel.

In general, do not mix the types of tests used for a person. The discordance between TST and IGRA results is ≤15%; in most instances of discordance, the TST result is positive and the IGRA is negative. Multiple reasons for the discordance exist, and clinicians cannot be confident about the reason for discordance in any single person. If a clinician does decide to mix tests, going from TST to IGRA is better than the other way around, because the likelihood of a discordant result with the TST negative and the IGRA positive is much lower. Such discordant results might become unavoidable as more medical establishments switch from TSTs to IGRAs.

When testing travelers who were born or took up residence in TB-endemic areas, consider the greater background prevalence of infection in these places. In a study among 53,000 adults in Tennessee, the prevalence of a positive TST results among foreign-born participants was >11× that of US-born participants (34% vs. 3%). Confirming M. tuberculosis test status before travel would prevent the conclusion that a positive result after travel was due to recent infection.

The following authors contributed to the previous version of this chapter: Neela D. Goswami, Philip A. LoBue

Bibliography

Hagmann SH, Han PV, Stauffer WM, Miller AO, Connor BA, Hale DC. Travel-associated disease among US residents visiting US GeoSentinel clinics after return from international travel. Fam Pract. 2014;31(6):678–87.

Lewinsohn DM, Leonard MK, LoBue PA, Cohn DL, Daley CL, Desmond E, et al. American Thoracic Society/Infectious Diseases Society/Centers for Disease Control and Prevention clinical practice guidelines: diagnosis of tuberculosis in adults and children. Clin Infect Dis. 2017;64(2):111–5.

US Preventive Services Task Force. Screening for latent TB infection in adults: US Preventive Services Task Force recommendation statement. JAMA. 2016:316(9):962–9.

. . . perspectives chapters supplement the clinical guidance in this book with additional content, context, and expert opinion. The views expressed do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC).

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The Complete Guide to the U.S. Immigration Medical Exam

The immigration medical exam is a crucial part of the green card application process. Under U.S. immigration law, all green card applicants must complete the immigration medical exam to confirm that they are in good health and are fit to live in the United States as permanent residents. This article explains the purpose of the immigration medical exam, what's involved in the process, how much the exam costs, how to find a doctor, and what medical tests you will undergo. It also explains certain health conditions that may make you "inadmissible" to the United States.

Written by Jonathan Petts .  Updated October 2, 2022

What is the immigration medical exam?

Receiving a medical examination is an essential part of your immigration process to obtain a  green card . Your green card application process is incomplete without the immigration medical exam. A  government-authorized doctor  will conduct the exam, which will include: 

Mental and physical examination 

Medical history and immunization or vaccine record review 

Drug and alcohol screening 

Testing for various illnesses and diseases

Why do I need to take the immigration medical exam?

 U.S. Citizenship and Immigration Services (USCIS) requires the immigration medical exam to protect the public health of the U.S. population. Anyone applying for  permanent residence  must undergo an immigration medical exam. Certain health conditions could make you “inadmissible” to the United States. In other words, you may be ineligible to receive a green card because of a current health condition or something in your health history. This is called “medical inadmissibility.”

"Medical Inadmissibility" — Health-related reasons for denial

There are five main health reasons for which U.S. Citizenship and Immigration Services (USCIS) could deny your green card application. These include communicable diseases that could affect public health, drug or alcohol abuse, mental or physical disorders associated with harmful behaviors, inability to work, and an incomplete vaccination record.

Reason 1: Communicable diseases that could affect public health

Suppose you have certain active, untreated, and infectious diseases (including gonorrhea, syphilis, leprosy, or tuberculosis). USCIS may deny you a green card until you are treated or cured and can enter the United States without infecting other Americans. 

Reason 2: Drug or alcohol abuse 

If your medical exam shows that you are currently abusing prescription drugs, illegal drugs, or alcohol, you may not be able to get a green card. If you have a history of abusing drugs, USCIS may ask you to take a drug test or verify you participated in a drug treatment program. 

Reason 3: Mental or physical disorders associated with harmful behaviors 

If you have an illness that could cause you to be violent towards yourself or others, USCIS may deny you a green card. USCIS considers drunk driving one of these disorders since it is harmful to other people besides the drunk driver. 

Reason 4: Inability to work 

If your health conditions prevent you from working and supporting yourself financially, USCIS may consider you ineligible to get a green card. This qualification depends on how likely you would become someone dependent on government benefits. Conditions such as serious fatal diseases could fall in this category. 

Reason 5: Failure to show proof you previously had your required vaccines 

If you cannot provide evidence that you obtained the proper vaccines to enter the United States, you may also be considered “inadmissible.” 

How to avoid “medical inadmissibility”

USCIS will not deny you a green card if you have a cold, a chronic, but well-managed disease, such as diabetes, are HIV positive or previously had an infectious disease, but have since been cured. There are also things you can do to try to prevent facing a health-related denial of your application. Here are some tips: 

If you had one of the contagious diseases (including gonorrhea, syphilis, leprosy, or tuberculosis) in the past, you need to show proof of treatment to USCIS. For example, you could bring copies of your medical records that show your treatment and test results, along with a statement from your regular doctor stating your disease is cured or under control. 

If you have a history of drug abuse, you should bring proof that you have received treatment. 

If you have a history of mental illness, you should bring proof you are managing your mental health well. 

If you have other serious diseases, you should bring a statement from your regular doctor that explains how you manage your condition. It should also explain how much your illness affects your life, including its impact on your ability to work. 

If USCIS denies your application for health-related reasons, you can apply for a “ waiver of inadmissibility ” or a government waiver to still enter the United States. USCIS will communicate with the Centers for Disease Control and Protection (CDC) about providing you a waiver. They could potentially create specific conditions on which they’ll approve your waiver. For example, you may have to see a doctor immediately and receive treatment in the United States if you have an infectious disease. However, USCIS could deny your waiver if you directly refuse to obtain treatment. You should only file a waiver of inadmissibility with the  help of a lawyer .

How do I prepare for my immigration medical exam?

To receive an immigration medical exam for your green card application, you need to find a government-approved doctor. Only some doctors are eligible to perform these exams. Your choice of doctors and whether you need to complete the appointment before your  scheduled interview  depends on your location. Read more about these preparation steps below! 

How do I choose a doctor for my immigration medical exam?

It is important to find the right  government-authorized doctor  for your  medical exam . If you are applying for an immigrant visa outside of the United States, your U.S. embassy or consulate can provide you with a list of panel physicians certified by the Department of State. You can most likely choose your physician, but you should check with your local consulate to make sure. If you are applying for an  adjustment of status  within the United States, a U.S. civil surgeon should examine you. 

The process of scheduling will also depend on your current location. 

If you're applying from inside the U.S.

You have two different options for scheduling your appointment if you’re in the United States. 

Option 1: Schedule it before beginning your green card application process

You can submit your medical exam results along with the rest of your application, which is called “ concurrent filing .” 

However, if you receive your exam before starting your green card application, your medical exam results must be signed by a civil surgeon within sixty days of filing your green card application. If your doctor signed the form more than sixty days before, you can’t do concurrent filing. You should instead wait to submit your medical form until after sending your green card application to the U.S. Citizenship and Immigration Services (USCIS), or you should bring the form to your interview. Otherwise, you have to repeat the medical exam. If you wait until after filing your green card application, you can send in or bring in your medical records within two years. 

Option 2: Schedule it after starting your green card application process

After submitting your green card application, you can send your medical exam results to USCIS or bring them to your green card interview. Your exam forms are valid for two years since the doctor signed your document. 

You can find a doctor through  USCIS’s webpage . Be sure to let them know you need an immigration medical exam before scheduling your appointment. 

If you're applying from outside the U.S.

You can schedule your medical exam after the National Visa Center (NVC) sends you an appointment letter for your  green card interview . The NVC is the State Department team that reviews green card applications for applicants outside of the United States. 

Before you receive your appointment letter, you should find  your local U.S. embassy or consulate . They will give you instructions for the exam and a list of approved doctors within your country. It is your choice which doctor to select. It is best to schedule your medical exam right after you receive an interview date and to let the medical office know you need an immigration medical exam. 

Your exam results are valid for six months unless you have certain medical conditions which could cause your exam results to expire in three months. At the end of your exam, you should check in with your physician about when your results expire. 

What should I bring to my immigration medical exam?

It’s important to prepare documents to bring to your  medical exam , so the process goes smoothly. You should bring these items along with you: 

Your vaccination records 

A copy of your medical history 

If applicable, copies of previous chest x-rays 

A letter from your regular doctor stating your treatment plan for any of your health problems 

A government-issued photo ID 

Payment for the medical exam fee — Check with the doctor’s office for payment options before your appointment

If applicable, your health insurance card — Check with the doctor’s office to see if they accept your insurance before the appointment 

The final documents you must bring depends on whether you are applying for a green card from inside or outside of the United States. 

You should bring  Form I-693 , officially named “Report of Medical Examination and Vaccination Record.” The  civil surgeon  will record your exam results on this document.

Even though most doctors can give you a copy of this form at their office, you should bring your copy of Form I-693 from  the USCIS website . It would help if you did this to make sure you have the latest version of the form. Sometimes doctors can forget to update their form version when USCIS changes it. If you file an old version, USCIS will reject it and ask you to resubmit the correct form version. You would have to return to the doctor’s office and delay your application. 

You can also fill out your portion of the form before arriving at the doctor’s office to save time. However,  don’t sign the record until the authorized doctor tells you to . The document requires you to sign it in the presence of a doctor. 

Afterward, the doctor will complete their portion of the form at the end of the exam, and ask you to sign.  

You need to bring your  green card interview  appointment letter from the National Visa Center (NVC) to the doctor’s office if you’re applying abroad. The doctor will use this letter to confirm your active green card application.  Without this letter, you will not receive an immigration-specific medical exam. 

How much does the USCIS medical exam cost?

The cost for your immigration medical exam can vary depending on the  authorized doctor  and the location of the exam. The U.S. government doesn’t standardize the fee, and prices can range from $100 to $400. You can check with several doctors to see how much they each charge, and make the decision that’s best for you. You should also factor in other indirect costs, such as transportation costs.  

What do they check in the immigration medical exam?

The  medical exam  will involve many different screenings. The screening processes may vary depending on whether you are applying for adjustment of status while located  inside the United States  or consular processing while  outside of the United States.  Regardless of whether you apply for an  asylum green card ,  child green card ,  parent green card ,  marriage green card , or any  other green card , the general categories of screenings will stay the same. The screening will include a tuberculosis test, vaccination screening, medical history review, physical exam, mental exam, drug and alcohol screening, and blood and urine screening. 

Tuberculosis Test

The Centers for Disease Control and Prevention (CDC) has different tuberculosis test guidelines depending on whether you are inside or outside the United States. 

If applying from the U.S.

The CDC requires the doctor to conduct an “interferon gamma release assay” (IGRA) test on all green card applicants ages two and older. You most likely won’t have to return to the doctor’s office to obtain results. 

However, if the IGRA test indicates you may have tuberculosis, you will have to undergo further testing and a chest x-ray. 

One important note is that the USCIS no longer accepts the tuberculin skin test (TST) for green card applicants within the United States. Be sure you receive the right kind of test. 

If applying from outside the U.S.

The CDC requires you to undergo a chest x-ray if you are fifteen and older and located in a country considered “heavily tuberculosis-burdened.” 

If the x-ray or any other medical examination results indicate you may have tuberculosis, you will have to return to the clinic for further testing. 

You should check for further tuberculosis exam instructions from your U.S. embassy or consulate. 

Vaccination Screening

The Immigration and Nationality Act requires certain vaccines, and the CDC requires others. You will need to prove you have received the following vaccinations:

Mumps, measles, and rubella 

Diphtheria toxoids and tetanus

Hepatitis A

Hepatitis B

Haemophilus Influenza Type B

Pneumococcal Pneumonia

Meningococcal

These guidelines could vary over time, so you can  check the list  U.S. Citizenship and Immigration Services (USCIS) provides. 

Medical History Review

The doctor will also check your medical history. They will specifically note:  

If you ever stayed in the hospital or had any significant events in your health history 

If you ever were disabled or highly sick and unable to function as an average member of society 

If you were ever in an institution for a chronic mental or physical condition 

Physical Exam

During your physical exam, your doctor will likely examine these areas: 

Extremities

Lymph nodes

External genitalia

You will also undergo a chest x-ray and blood test to check for syphilis. USCIS will excuse  child green card  applicants from this requirement. 

If you are pregnant, contact your embassy or consular office to ask for a postponement in your medical examination  filing process. An x-ray could harm your pregnancy. 

Mental Exam

Your doctor will also examine your mental health. They will likely assess your intelligence, judgment, mood, behavior, and comprehension. 

They will especially note: 

Current mental or physical disorders associated with harmful or violent behavior 

Past mental or physical conditions associated with dangerous or violent behavior and that are likely to reoccur 

If these two categories apply, you could be inadmissible. 

Drug & Alcohol Screening

The doctor will also ask you about any prescription drugs you take, your past and current drug and alcohol use, and whether you have had a history of substance abuse. If you are currently abusing substances, you will not qualify for a  green card . If you can prove you have recovered, you are still eligible. 

Blood & Urine Screening

You will receive a blood test to check for syphilis and a urine test to check for gonorrhea if you are older than fifteen. This test applies whether you are inside or outside of the United States. 

It’s important to note that even if you are having a menstrual period, you still must complete the medical exam.

If you are pregnant, you must give consent before undergoing a chest x-ray. The doctor will provide extra protection. You can also postpone the chest x-ray until after giving birth. Still, you must complete it before entering the United States if you are currently living abroad or before completing your green card application or  Form I-485  if you are applying from within the United States. 

What happens after the immigration medical exam?

After you complete your immigration medical exam for your  green card , your next steps will depend on whether you are applying for consular processing outside of the United States or adjustment of status within the United States. Regardless, be sure to sign your forms when your doctor asks. Otherwise, U.S. Citizenship and Immigration Services (USCIS) will not accept them. 

Your doctor will provide you an unopened, sealed envelope of your medical records and your  Form I-693 . Do not open this envelope and break the seal, or USCIS will not accept it. Send the envelope to USCIS or bring it to your  green card interview , depending on whether you schedule your medical exam before or after filing your application. 

Your doctor may give you a sealed, unopened envelope and x-ray results to bring to your green card interview. They may also directly send your results to your U.S. embassy or consulate. It depends on your home country’s requirements for your medical exam. 

Continue reading and learning!

Tuberculosis (TB)

Testing for tuberculosis (tb).

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Tuberculin skin test (tst), testing for tb in people with a bcg, tb blood tests, choosing a tb test, diagnosis of latent tb infection or tb disease, related links.

Tuberculosis (TB) is a disease that is spread through the air from one person to another. When someone who is sick with TB coughs, speaks, laughs, sings, or sneezes, people nearby may breathe TB bacteria into their lungs. TB usually attacks the lungs, but can also attack other parts of the body, such as the brain, spine, or kidneys.

TB bacteria can live in the body without making a person sick. This is called latent TB infection. People with latent TB infection do not feel sick, do not have TB symptoms, and cannot spread TB bacteria to others. Some people with latent TB infection go on to develop TB disease . People with TB disease can spread the bacteria to others, feel sick, and can have symptoms including fever, night sweats, cough, and weight loss.

There are two kinds of tests that are used to determine if a person has been infected with TB bacteria: the tuberculin skin test and TB blood tests.

What is a TST?

The Mantoux tuberculin skin test is a test to check if a person has been infected with TB bacteria.

How does the TST work?

Using a small needle, a health care provider injects a liquid (called tuberculin) into the skin of the lower part of the arm. When injected, a small, pale bump will appear. This is different from a Bacille Calmette-Guerin (BCG) shot (a TB vaccine that many people living outside of the United States receive).

The person given the TST must return within 2 or 3 days to have a trained health care worker look for a reaction on the arm where the liquid was injected. The health care worker will look for a raised, hard area or swelling, and if present, measure its size using a ruler. Redness by itself is not considered part of the reaction.

What does a positive TST result mean?

The TST result depends on the size of the raised, hard area or swelling. It also depends on the person’s risk of being infected with TB bacteria and the progression to TB disease if infected.

• Positive TST: This means the person’s body was infected with TB bacteria. Additional tests are needed to determine if the person has latent TB infection or TB disease. A health care worker will then provide treatment as needed.
• Negative TST: This means the person’s body did not react to the test, and that latent TB infection or TB disease is not likely.

Who can receive a TST?

Almost everyone can receive a TST, including infants, children, pregnant women, people living with HIV, and people who have had a BCG shot. People who had a severe reaction to a previous TST should not receive another TST.

How often can a TST be given?

Usually, there is no problem with repeated TSTs unless a person has had a severe reaction to a previous TST.

People who have had a previous BCG shot may receive a TST. In some people, the BCG shot may cause a positive TST when they are not infected with TB bacteria. If a TST is positive, additional tests are needed.

What is an Interferon Gamma Release Assay (IGRA)?

An IGRA is a blood test that can determine if a person has been infected with TB bacteria. An IGRA measures how strong a person’s immune system reacts to TB bacteria by testing the person’s blood in a laboratory. Two IGRAs are approved by the U.S. Food and Drug Administration (FDA) and are available in the United States:

• QuantiFERON®–TB Gold In-Tube test (QFT–GIT)
• T–SPOT®.TB test (T–Spot)

How does the IGRA work?

Blood is collected into special tubes using a needle. The blood is delivered to a laboratory as directed by the IGRA test instructions. The laboratory runs the test and reports the results to the health care provider.

What does a positive IGRA result mean?

• Positive IGRA: This means that the person has been infected with TB bacteria. Additional tests are needed to determine if the person has latent TB infection or TB disease. A health care worker will then provide treatment as needed.
• Negative IGRA: This means that the person’s blood did not react to the test and that latent TB infection or TB disease is not likely.

Who can receive an IGRA?

Anyone can have an IGRA in place of a TST. This can be for any situation where a TST is recommended. In general, a person should have either a TST or an IGRA, but not both. There are rare exceptions when results from both tests may be useful in deciding whether a person has been infected with TB. IGRAs are the preferred method of TB infection testing for the following:

• People who have received the BCG shot
• People who have a difficult time returning for a second appointment to look at the TST after the test was given

How often can an IGRA be given?

There is no problem with repeated IGRAs.

Who Should Get Tested for TB?

The Centers for Disease Control and Prevention (CDC) and the United States Preventive Services Task Force (USPSTF) recommend testing populations that are at increased risk for TB infection. Certain people should be tested for TB bacteria because they are more likely to get TB disease, including:

• People who have spent time with someone who has TB disease
• People with HIV infection or another medical problem that weakens the immune system
• People who have symptoms of TB disease (fever, night sweats, cough, and weight loss)
• People from a country where TB disease is common (most countries in Latin America, the Caribbean, Africa, Asia, Eastern Europe, and Russia)
• People who live or work somewhere in the United States where TB disease is more common (homeless shelters, prison or jails, or some nursing homes)
• People who use illegal drugs

Choosing which TB test to use should be done by the person’s health care provider. Factors in selecting which test to use include the reason for testing, test availability, and cost. Generally, it is not recommended to test a person with both a TST and an IGRA.

If a person is found to be infected with TB bacteria, other tests are needed to see if the person has TB disease. TB disease can be diagnosed by medical history, physical examination, chest x-ray, and other laboratory tests. TB disease is treated by taking several drugs as recommended by a health care provider.

If a person does not have TB disease, but has TB bacteria in the body, then latent TB infection is diagnosed. The decision about taking treatment for latent TB infection will be based on a person’s chances of developing TB disease.

• CDC Tuberculosis (TB)
• Basic TB Information

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• Page last reviewed: September 1, 2016
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• Division of Tuberculosis Elimination

TB Test Certificate Guide for UK Visa Applications

All applicants for long term UK visas from countries where TB is common must be screened for active TB in the lungs as part of their UK visa application.  In this guide to TB screening for the UK we answer a number of frequently asked questions about TB and TB screening requirements for UK visa applications.

Do I need to be tested for TB before coming to the UK?

A tuberculosis (TB) test is required by an Applicant if they are coming to the UK for more than 6 months and they are resident in any of the countries listed by the UK government.

Appendix T: tuberculosis screening of the Immigration Rules reads:

Any person applying to enter the UK as described in paragraph A39, Part 1 General Provisions of the Immigration Rules, must present at the time of application a valid medical certificate issued by a medical practitioner approved by the Secretary of State for these purposes, as listed on the Gov.uk website, confirming that they have undergone screening for active pulmonary tuberculosis and that such tuberculosis is not present in the applicant.

Paragraph A39 of the Immigration Rules reads:

A39. Any person making an application for entry clearance to come to the UK for more than six months or as a fiancé(e) or proposed civil partner applying for leave to enter under Section EC-P:Entry clearance as a partner under Appendix FM, having been present in a country listed in Appendix T for more than six months immediately prior to their application, must present, at the time of application, a valid medical certificate issued by a medical practitioner approved by the Secretary of State for these purposes, as listed on the Gov.uk website, confirming that they have undergone screening for active pulmonary tuberculosis and that this tuberculosis is not present in the applicant.

It is important to note that this requirement applies ‘at the time of application’ and depending on the country of residence, may apply to applications for leave to enter as a fiancé(e) or proposed civil partner, even though a successful application will result in a grant of leave to enter only for a six month period. 

When might a TB certificate not be required?

A TB test is not required in the following circumstances:

• The Applicant is a diplomat accredited to the UK
• The Applicant is a returning resident and they have  not been away for more than 2 years
• The Applicant has lived for at least 6 months in a country where TB screening is not required by the UK and they have been away from a country for no more than 6 months.  

In accordance with paragraph B39 an Applicant seeking leave to enter as a returning resident under paragraph 19, and who has therefore been absent for more than two years, is subject to the requirements in paragraph 39.  

Paragraph C39 reads:

Where a person has lawfully been present in a country not mentioned in Appendix T for more than six months and they are applying for entry clearance as in A39 in a country in Appendix T but have not been in that country or any other country mentioned in Appendix T for more than six months immediately before making their application, they will not be required to produce a medical certificate showing they are free from active pulmonary TB. This does not alter the discretionary powers as in paragraph 39 below.

It is important in considering the application of paragraph C39 to note the use of the word ‘lawfully’.

How long is a TB certificate valid for?

Following a test which shows the Applicant does not have TB, the Applicant will be provided with a certificate which should be submitted with the visa application documents. 

It is important to note the certificate is only valid for 6 months from the date it is issued.  An applicant will therefore need to consider the timing of any application and factor in the practicalities of arranging and travelling to an appointment  at an approved clinic. 

What happens at the TB test at an approved clinic?

An Applicant will need to take to their appointment their passport and one other official document confirming their identity.  In addition they should take two passport photographs and their medical records including, if applicable, any details of a previous diagnosis of TB and treatment. 

Ordinarily an Applicant will be given a chest x-ray to test for TB.  If this is not clear or there are concerns the Applicant may be asked to provide a sputum sample. 

There are special arrangements for children and pregnant women.  All children will need to see a physician who will decide if they need a chest x-ray.  Children under 11 will not usually have a chest x-ray.  A  health questionnaire will be completed and if a clinician makes a decision meaning the child does not have TB they will issue a certificate. 

Pregnant women can choose either an x-ray with extra shield in the 2nd and 3rd trimesters, a sputum test, or to wait until they have delivered.  If opting for the sputum test there may be an extra fee and it can take up to 8 weeks to receive a result. It may be possible to rely on an x-ray taken within the last 3 months at one of the approved clinics.  A clinician at an approved clinic may be able to review this. 

If there is a test positive for TB the Applicant will be referred for treatment; once the treatment is complete they can be re-screened for an additional fee.  A diagnosis will be reported in accordance with the requirements of any country and to the UK health authorities. 

Where will I need to go to be tested for TB?

The list of countries can be accessed: here .  Each country has a list of approved clinics. The valid medical certificate must be issued by a medical practitioner approved by the Secretary of State and appearing on the Gov.uk website.  Clinic fees will depend country to country and are payable  in addition to any UKVI application fees. 

Applicants may  need to take a test in a neighbouring country, for example Applicants from Cape Verde, Guinea Bissau and Mali will need to take a test in Gambia or Senegal and those from Mauritania will need to be screened in Morocco.  This is a practical consideration for many Applicants in planning their visa application. 

General Discretion – Immigration Rules 

Paragraph 39 of the Immigration Rules does give a general discretion for Entry Clearance Officer as there is for an Immigration Officer:

• The Entry Clearance Officer has the same discretion as an Immigration Officer to refer applicants for entry clearance for medical examination and the same principles will apply to the decision whether or not to issue an entry clearance.

What will happen if I apply for a visa and do not supply a TB test certificate?

If an Applicant submits an application and does not provide the TB certificate the entry clearance application is likely to be refused.

Do I require a TB test certificate for an application for leave to remain? 

An Applicant will only need to provide a TB certificate if making an application for entry clearance from outside the UK when required to do so.   There is no requirement to provide a certificate when making an application from within the UK.  

Contact our Immigration Barristers 

For expert advice and assistance relating to a TB certificate or any related visa application, contact our immigration barristers on 0203 617 9173 or complete our enquiry form below.

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TB Test Guide for UK Visa Applications

• Anne Morris
• 2 November 2021

IN THIS SECTION

If you are planning to come to the UK to stay for over six months and are a resident of one of a number of countries specified by the British Government, you will need to have a tuberculosis (TB) test before you are allowed to enter the country.

The purpose of screening for TB is to detect the presence of lung TB and prevent transmission to others when travelling, while also helping with early detection and treatment where the traveller is unaware of their condition.

After you have been screened for TB, if the tests are clear, you will be issued a TB clearance certificate. The certificate confirms you are free of lung TB and is a mandatory requirement before you can apply for a visa to enter the UK.

Countries where you need a TB test to enter the UK

Pre-entry screening is compulsory for those people who wish to come into the UK and stay for over six months if they are a national of one of the following countries, as listed on the .gov website (as at November 2021). Screening is not required if you are coming to the UK as a tourist .

Do all UK visa applicants need to be tested for TB?

If you are planning to come from a country where TB is common and are applying for a long-term visa, then you must be screened. There are specific screening rules that apply to children under the age of eleven and pregnant women.

Where the screening takes place

The test is taken at your own convenience in your country of residence. It is not done on arrival in the UK. You will need to make an appointment to be screened at a designated and UK government approved clinic in your home country. This is done on behalf of the UK Immigration Authority. You can find a list of approved clinics on the gov.uk website.

Things you will need to take to the appointment

You will need to take two official documents proving your identity, one of which must be your passport. Besides this requirement, you will also need two recent passport sized photographs, payment for your TB screening test, and your medical records. If you have previously had a TB test, you should provide details of the previous results, diagnosis, and any treatment you may have received.

How much does a TB test UK cost?

The clinic fee varies from country to country and covers the consultation, chest X-ray, and the TB clearance certificate. If further tests, such as sputum tests, are thought to be necessary by your doctor, additional costs may be incurred. The clinic fees for the TB test are in addition to the cost of your visa application to the UK Home Office.

What is the TB test procedure?

Although almost all cases of TB can be treated and cured, delays in diagnosis and other factors mean it remains a serious condition. TB can affect any part of someone’s body, but the risk of transmission only happens when the active disease is in the lungs. This means that pre-entry screening only covers active TB in the lungs. This is a type of TB affecting the lungs and can be difficult to diagnose. You may have a chest X-ray to look for changes in the appearance of your lungs that may suggest TB. Samples of phlegm are also often taken and checked for the presence of TB bacteria.

Before screening begins, you will be required to complete the Informed Consent Form at the clinic. The doctor will then ask you about any current health complaints, worries or symptoms you may have, previous illnesses (including TB) and treatment, and whether you have had a friend or relative with TB. If the doctor considers it appropriate they may carry out a physical examination.

Chest X-ray

You will be given a chest X-ray that can identify any changes in your lungs, which may indicate lung TB. Your results are generally ready to be collected within 24 hours. If your doctor does not think you have TB (following consultation and chest X-ray), they will issue you with a TB certificate.

Sputum Test

If your chest X-ray shows areas of concern, or if the test results are inconclusive, your doctor will ask you to provide three samples of sputum (phlegm coughed up from the lungs). This is done in the clinic on three consecutive mornings, so you should be prepared to attend the clinic. The samples you provide will then be analysed under a microscope. Sometimes the TB bacteria can be seen with a special stain process. However, more often the TB bacteria will grow in a culture of the sample you have provided, therefore all samples will be cultured. It is important to note that in these cases, the final diagnosis can take around two months to get.

Are there any exemptions to taking a TB test UK?

There are certain circumstances where you do not have to undergo TB screening. You will not need to take a TB test UK if you are a diplomat accredited to the UK, you are a UK resident returning to the UK providing you have not been away for over two years, or you lived in a country for at least six months where TB screening is not required by the UK and you have not been away from that country for over six months.

Can a whole family be screened together?

If you are intending to come to the UK with your family, the clinic should allow screening of all your family members on the same day.

Children and pregnant women

All children who are coming to the UK and applying for a visa from a listed country are required to show they are free of TB and will need to see a doctor to confirm this.

Children under the age of eleven will not usually be required to have a chest X-ray, however, the child must be taken to an approved clinic to complete a health questionnaire. If the doctor decides your child does not have TB, they will give you a certificate which you should include within your child’s UK visa application.

Pregnant women can request a chest X-ray with an extra shield to protect them and their unborn child in the second and third trimesters or take a sputum test instead. If they decide to take the sputum test, there may be an additional fee and they could have to wait up to eight weeks for the results. Alternatively, they can wait until after the child is born and take the chest X-ray then.

How long is a TB certificate valid for?

A TB clearance certificate is valid for six months from the date it is issued. After you have entered the UK, health authorities may contact you to offer a further screening test for inactive – or latent – TB. This is in addition to the pre-entry screening you had in your home country and is to prevent reactivation of this type of TB.

Testing for latent TB

Latent TB is where someone has been infected with TB, but they do not display any symptoms. For example, if you have been in close contact with someone who is known to have active TB, you may need to have a test or if you have recently spent time or live in a country where TB levels are high.

The Mantoux test is commonly used to test for latent TB. It involves injecting a tiny amount of PPD tuberculin into the skin of your forearm. This may also be called the tuberculin skin test (TST). If you have a latent TB infection, your skin will have a sensitivity to the PPD substance and a small red bump will develop at the injection site, typically around 48 to 72 hours after having the test.

If your skin has a particularly powerful reaction, you may need to go on to have a chest X-ray to confirm if you have active TB. If your skin does not react to the test, you do not have latent TB infection. Although if you have previously received a BCG vaccination, you could have a mild skin reaction to the test, but this does not necessarily mean you have latent TB.

There is a new blood test for TB that is becoming more widely available and is called the interferon gamma release assay (IGRA). The IGRA may be used to help diagnose latent TB if:

• You have had a positive Mantoux test
• You previously had a BCG vaccination – as discussed above, the Mantoux test may not be reliable in such cases
• You have recently moved to the UK from a country where TB is common
• As part of a health check when you register with a GP in the UK
• You are going to have treatment that will suppress your immune system (immunosuppressant treatment)
• If you have come to the UK to be a healthcare worker

How will testing positive for TB affect my visa application?

If you test positive for TB, you will be referred straightaway by your doctor for antibiotic treatment. Although you will not be issued with a clearance certificate, you can reapply following successful completion of your treatment. Your doctor will report your diagnosis of lung TB to your local, regional or national authorities following the requirements of your country. Your doctor will also report your diagnosis to the UK health authorities.

After completing your treatment (generally after six months), you are eligible for re-screening. This will incur an additional fee. Prior to applying for your UK visa, you will need a screening clearance certificate from an approved clinic, confirming you are now free of lung TB.

If you no longer have TB, the certificate will be issued and you can then include it within your visa application. A previous diagnosis of TB will not have any adverse effect on the visa process if you are subsequently certified free of TB.

Need assistance?

DavidsonMorris’ immigration lawyers advise on all aspects of UK visa applications, including entry requirements such as TB testing. For specialist advice, contact us.

TB test for the UK FAQs

How do you get a tb test uk.

You should contact your closest approved clinic directly and book an appointment for a TB screening test; making it clear that you require the test for a UK visa application. You can find your nearest clinic by checking on the gov.uk website.

Can I do TB test in UK?

No. You will need to take the test in your home country before applying for a UK visa to enter the UK. You cannot take the test in the UK.

How much does a TB test cost UK?

The costs of testing varies from country to country and includes the consultation, the screening test, and certificate of clearance. Other tests, such as sputum tests, may be required, which will incur additional costs.

Do I need a TB test every year?

Further testing is not required, providing you have lived at least six months in a country where TB screening is not required by the UK, and you have been away from that country for no more than six months.

Last updated: 2 November 2021

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• Entering and staying in the UK
• Visas and entry clearance
• Tuberculosis (TB) testing

Tuberculosis testing: Home Office approved clinics

Lists of clinics where visa applicants can get tested for tuberculosis (TB).

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Added link to Vanuatu: tuberculosis test clinics for a UK visa.

Added link to Laos: tuberculosis test clinics for a UK visa.

Added link to UK tuberculosis test clinics for Hong Kong British National (Overseas).

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