Arrival notifications
The Centers for Disease Control and Prevention (CDC) notifies the Department of Public Health of all refugees arriving in Massachusetts from overseas. With few exceptions, refugees enter the U.S. through a port of entry with a Quarantine Station. The pre-departure medical examination forms, immunization records and pre-departure treatments are included in the notifications.
Overseas Medical Screening
The purpose of the overseas (pre-departure) medical screening is to identify individuals with health-related conditions that are excludable under the U.S. immigration law. The medical screening is required for all refugees and overseas applicants for immigrant visas.
The specific conditions of concern are communicable diseases of public health significance, drug addiction, and mental health conditions associated with violence.
Refugees receive immunizations prior to departure. In many regions of the world, refugees complete a pre-departure medical screening, at which time they receive final clearance for travel and, depending on the departure country, may receive presumptive treatment for parasites, malaria, and additional vaccinations.
Refugee Health Assessment Program
All refugees are eligible for medical services, including the initial domestic medial screening known as the Refugee Health Assessment Program (RHAP) in Massachusetts. The RHAP uses a public health framework and removes barriers that may prevent newly arrived refugees from accessing early medical diagnosis and treatment. The program is tailored to refugee experiences and needs, and so is different from a typical physical exam. RHAP providers have expertise in refugee populations, overseas medical screening processes, and refugee health recommendations. The RHAP also facilitates follow-up of conditions identified during an overseas medical screening.
Refugee Health Assessment: A Guide for Health Care Clinicians
The Refugee Health Assessment Program Guide for health care clinicians describes the components of the health assessment, and provides instructions for contracted providers in Massachusetts to complete the program form.
Download the Refugee Health Assessment Program Guide.
Immunizations Provided During Refugee Health Assessment
Refugees receive overseas immunizations, depending on vaccine availability in departure countries or in refugee settings prior to travel. Domestic health assessment providers review vaccines administered overseas and determine the validity of vaccine doses based on guidance from the Advisory Committee on Immunization Practices. They then initiate or continue catch-up immunizations as appropriate.
Adjustment of Status
Persons applying for adjustment of status to permanent resident from within the U.S. also complete a medical examination. As with the overseas medical screening, the technical instructions are written by the Centers for Disease Control and Prevention.
Refugees do not complete the full examination. Refugees are only required to complete the vaccination requirements. The U.S. Citizenship and Immigration Services provides a blanket certification for public health departments to complete the vaccination assessment and all associated forms for refugee applicants.
Additional Resources
- CDC information:
- Domestic guidelines for medical examination during refugee health assessment:
- Advisory committee on immunization practices, domestic immunization guidelines:
- Civil Surgeon information: