Refugee Medical Screening
A refugee medical screening (RMS) also known as a health assessment is an important first step for refugees and new comers resettling in the U.S. to receive medical care. The screening should be done within 90 days of arriving in North Dakota.
The goal of the refugee medical screening is to support and promote the health and well-being of refugees and newcomers that arrive in North Dakota. The Health and Human Services Office of Refugee Services team trains health care providers to provide the best care possible to refugees and newcomers arriving in North Dakota.
The refugee medical screening is a comprehensive physical examination of all family members and an opportunity to identify any physical and mental health concerns that could prevent refugees and newcomers from employment, attending school, gaining economic self-sufficiency, and integration. During the visit, health care providers will also refill medication and help ensure refugees and newcomers are connected to a primary care doctor and provide referrals to specialty doctors if needed.
Screenings are performed by medical providers and may take two visits, that include:
- Review of overseas medical examination
- Assessment of current health
- A physical examination
- Lab work
- Immunizations
The medical screening may require a second visit. Arriving for future follow-up appointments and completing subsequent appointments on time is crucial.
Screening results do not effect immigration status. The purpose of the screening is to help refugees and newcomers stay healthy and are able to successfully settle in North Dakota.
Schedule a screeningOr Contact a refugee medical screening clinic near you
General Questions
The overseas examination is primarily limited to identifying medical and mental health conditions that prevent resettlement in the U.S. This can include communicable diseases, physical and/or mental conditions associated with harmful behaviors, substance abuse, or addiction.
The purpose of the refugee medical screening is to support the health and well-being of refugees and newcomers that have already undergone the overseas examination and have resettled in North Dakota.
No, all Office of Refugee Resettlement (ORR) eligible populations, such as Ukrainian humanitarian parolees, Cuban Haitian entrants, Special Immigrant Visa (SIV) holders, asylees, and certified victims of human torture, are eligible for these visits. This visit is also for people of every age.
Bring the following items for you and your family if you have them:
- I-94 and identification cards
- Medical records (overseas and domestic)
- Immunization records
- Any medications or herbs you may use
Most arrivals do not have to pay for the refugee medical screening as long as it is performed by a doctor authorized by the Office of Refugee Services. Medicaid or Refugee Medical Assistance will usually cover the cost. However, in certain cases, there may be a nominal co-pay, and depending on the household income, there may be a client share for Refugee Medical Assistance-eligible clients.
- Bring documents such as I-94s, identification cards, passports, medical records (overseas and domestic), immunization records, etc., that you may have for yourself and your family.
- You and your family are typically scheduled on the same day for your refugee medical screening appointments. Depending on the size of the family, it may take longer to complete the visits. Pack necessary items such as medications, snacks, extra diapers, or anything else you may need while waiting.
- Arrive on time as instructed by the refugee medical screening provider or your case manager. Arriving late will result in cancellations of your appointment/s. Notify your case manager as soon as possible if you need to reschedule due to an emergency or urgent need.
Please seek assistance from your case manager regarding transportation or other barriers that may prevent you from keeping your appointment.
Check in with the staff person at the front desk.
- You will complete the paperwork. This is a normal practice for any new patients. Please request an interpreter if necessary.
- You and your family may have to wait before you are directed to an exam room where the doctor and nurse/s will meet all family members.
- You may have to provide your and your family’s name and date of birth multiple times during this visit. This is to ensure proper identification. It may be helpful to have the birthdates written down.
- Please note that refugee medical screenings may require blood tests and immunizations.
- Please do not leave except in an emergency.
- Please complete all testing and pick up your medications (if any) before leaving the clinic. Your refugee medical screening may require a second visit. Arriving for future follow-up appointments and completing your subsequent appointments on time is crucial.
- You have the right to free interpretation services. It can be in-person or virtual.
- You have the right to express your desire to be seen by a doctor of a specific gender. Ask your case manager before the appointment. They can contact the clinic beforehand to make arrangements.
- You have the right to privacy, covered under U.S. HIPAA law. All your personal and health information will remain confidential.
- The health care clinic may have its own rights and responsibilities document that you can request.
A refugee medical screening involves many different things that are not usually done by providers during normal clinic visits. This includes testing for and treating illnesses that are more common in different countries and reviewing immunization and medical records from other countries.
You can submit a request to schedule a screening here or you can contact the Office of Refugee Services, State Refugee Health Coordinator by email at refugeeservices@nd.gov or by phone at (701) 298-4663, and we will connect you to a case manager and local health care provider to schedule an appointment.
No. This visit is only to help you stay healthy and has no effect on immigration status.
Refugee Medical Screening: Provider Guidance
These guidance are designed for health care providers who perform Refugee Medical Screening. Providers should reference the guidance and resources for the recommended components of the examination. The components of the examination available here, are based upon the recommendations of the Immigrant and Nationality Act of 1980, the Office of Refugee Resettlement: Refugee Medical Screening revised guidelines issued in 2013, and the CDC: Guidance for the U.S. Domestic Medical Examination for Newly Arriving Refugees. Some guidance has been adapted based on State protocols. All Office of Refugee Resettlement populations are referred to as refugees in this guide.
General Laboratory Testing
- Perform complete blood count with differential and comprehensive metabolic panel for all refugees.
- Perform urinalysis if symptomatic.
- Perform urine pregnancy tests for all women and children of childbearing age.
- Perform lead screening for all refugee infants and children under 17 years old. Refugees over 17 years old should be screened if there is a high index of suspicion, or clinical signs/symptoms of lead exposure.
- Perform other general labs as appropriate per provider discretion.
Tuberculosis (TB) Screening
Screen refugees for TB using Interferon-gamma release assay (IGRA) or Tuberculin skin test (TST).
IGRA is preferred for refugees 2 years and older. TST is preferred for children under 2 years old. Uniting for Ukraine program doesn’t require TB testing for children under 2 years old.
For those with positive IGRA or TST, ensure symptom screen, determine HIV status, chest x-ray, and sputum testing should be performed as indicated to rule out active TB.
All latent and active TB should be referred to local public health unit for treatment.
Hepatitis B Screening
- All newly arriving refugees should be tested for HBV infection regardless of overseas medical examination results. Serologies for hepatitis B should include HBsAg, hepatitis B surface antibody (anti-HBs), and total hepatitis B core antibody (anti-HBc).
- Those who do not have HBV infection or immunity, and are unvaccinated or have partial vaccine series should be offered hepatitis B vaccine series according to the ACIP-recommended schedule.
- Refer refugees with chronic HBV infection for further evaluation and management.
Hepatitis C Screening
- Screen all refugees 18 years and older with anti-HCV.
- Screening is recommended for all pregnant women.
- Screening is not routinely recommended to all new refugee children under 18 years old except for unaccompanied refugee minors (URM), children with risk factors, and children born to HBV-positive mothers.
Other forms of viral hepatitis
- Routine screening for hepatitis D virus (HDV) infection is not recommended. Testing is recommended for those who are HBsAg-positive.
- Routine screening for hepatitis A virus (HAV) infection is not recommended. HAV vaccination is recommended for children in accordance with ACIP recommendations, as well as select adults.
- Routine screening for hepatitis E virus (HEV) infection is not recommended.
Sexual and Reproductive Health Screening
- Syphilis
- Screen all refugees 18 years and older using RPR or VDRL with titer and reflex to treponemal specific tests, if no overseas documentation is available.
- Screen refugees 18 years and younger using RPR or VDRL with titer and reflex to treponemal specific tests, who are at risk for congenital syphilis, sexually active, or have been sexually assaulted.
- Gonorrhea and Chlamydia
- Screen all refugees between 18-24 years old if no overseas documentation is available.
- Screen refugees 18 years and younger or older than 24 years if there is a reason to suspect infection, or if there are risk factors.
- Screen female refugees with abnormal vaginal or rectal discharge, intermenstrual vaginal bleeding, or lower abdominal or pelvic pain.
- HIV Infection
- Screening all refugees between 13-64 years old. Screening for others is also encouraged.
Intestine Parasite Testing
- Evaluate all refugees for eosinophilia by obtaining a CBC with differential. If positive for eosinophilia, re-check for eosinophilia 3-6 months after arrival.
- Asymptomatic refugees who did not receive overseas presumptive treatment may be treated presumptively at arrival.
A test and treat approach can be followed for symptomatic refugees or those with contraindications.
Immunizations
- Evaluate any previous vaccines, lab evidence of immunity, or history of the disease.
- Doses are valid if given according to ACIP vaccine recommendations and schedules. If the patient presents with no documentation, assume he/she is not vaccinated.
- Administer age-appropriate vaccines, complete any initiated series, do not restart a vaccine series.
- Laboratory evidence of immunity is an acceptable alternative.
- Vaccinations are part of the USCIS’s I-693 Report of Medical Examination and Vaccination Record. All refugees must submit an I-693 form to USCIS form to adjust their status. Effective October 1, 2021, COVID-19 vaccination for age-appropriate individuals is required.
Mental Health Screening
- Mental Health screenings are recommended for all refugees 14 years and older. It is to be conducted during refugee medical screening using mental health screening tools such as Refugee Health Screener 15 (RHS-15) or a combination of other mental health screening tools. It may be repeated 3-4 months after arrival, depending upon results from refugee medical screening.
Children 2 years and under only require CDC, TST test, and lead testing.