Medical Screening

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Medical Screening

A medical screening (RMS), also known as a health assessment, is an important first step for refugee eligible individuals 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 medical screening is to identify and address health conditions, support and promote health and well-being, orient to the US healthcare system, and connect refugee eligible individuals to ongoing care to help them overcome barriers to employment, attending school, achieving economic self-sufficiency, and integration. Clinical judgment and local risk factors should be used when implementing these recommendations. The ND Office of Refugee Services trains health care providers to provide the best care possible to refugees and newcomers arriving in North Dakota. 

The medical screening includes a health exam, labs, and vaccines. During the visit, health care providers can also fill medications and help ensure that refugees and newcomers are connected to primary care and specialty care, if needed. 

Screenings are performed by medical providers and may take up to two visits, which include: 

  • Review of overseas medical examination
  • Office visit
  • Labs
  • Vaccines
  • Referrals

Screening results do not affect resettlement or immigration status. The purpose of the screening is to help refugees and newcomers stay healthy and successfully settle in North Dakota.

Contact a Medical Screening Provider Near You

 

General Questions

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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 medical screening is to complete and support the health and well-being of refugee-eligible individuals who have 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 this exam. 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)
  • Vaccine records
  • Insurance card, if available
  • Any medications or herbs you may use 

Most arrivals do not have to pay for the 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. In some cases, there may be a nominal co-pay, and depending on household income, a client share.

  • Bring documents such as I-94s, identification cards, health care insurance, passports, medical records (overseas and domestic), vaccine records, etc., that you may have for yourself and your family.
  • You and your family are typically scheduled on the same day for your 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 medical screening clinic, case manager, or health navigator. Arriving late will result in cancellation of your appointment. Notify your case manager or health navigator as soon as possible if you need to reschedule due to an emergency or urgent need. 

Please seek assistance from your case manager or health navigator regarding transportation or other barriers that may prevent you from keeping your appointment.

Check in with the staff person at the front desk upon arrival to: 

  • Complete registration paperwork. This is a normal practice for any new patient. Please request an interpreter if necessary.
  • Provide your 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.
  • Provide your and your family member'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.
  • Do blood tests and administer vaccines.

  • Complete all testing and pick up your medications (if any). 

    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 or health navigator 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.

Medical screening includes multiple areas that providers may not usually address during normal clinic visits. This includes testing for and treating illnesses that are more common in different countries and reviewing vaccine 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 via email at refugeeservices@nd.gov or by phone at (701) 298-4663, and we will connect you to a case manager, health navigator, or 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.

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Medical Screening: Provider Guidance 

This guidance is designed for health care providers who perform medical screening (RMS). The examination components available here are based on 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.

Key Considerations

Medical interpretation

  • Professional medical interpreters should be provided in-person or using a professional remote interpreter service (phone or video) for any patient who speaks a primary language other than English. Review the Working Effectively with an Interpreter checklist for steps to improve interpreter, healthcare professional, and patient interactions.

Gender Considerations

  • Patients may prefer to work with a healthcare professional of their own gender. This may include interpreters, medical assistants, and nurses. If adequate staffing is available, such requests should be honored.

Consent and Confidentiality

  • Review consent, confidentiality, and limits to confidentiality (e.g., mandatory reporting) with patients at the beginning of the first visit in the patient’s preferred language. This overview should include a discussion of who can access medical records and health information, and adult patients’ rights to make their own healthcare decisions.
  • It is important to explain that confidentiality extends to support staff (including interpreters and social workers). Providers and support staff are not permitted to share any health information with community members.

 

History and Exam

  • Review medical records (overseas and domestic), including vaccine records if available

  • During the RMS appointment, address immediate health concerns/priority needs and obtain a detailed history (e.g. family history, travel history).
  • Conduct a thorough exam as permitted by the patient, as this may reveal undiagnosed underlying disease and other medical issues.
  • Perform vision and hearing screening if able.

  • Refer to primary care as applicable

    Learn more recommendations for post arrival history and examination. 

General Laboratory Testing Recommendation

  • Perform complete blood count with differential and comprehensive metabolic panel for all refugees.
  • If an infant is seen for RMS, a newborn screening panel should be conducted according to state guidelines.
  • Perform urinalysis if symptomatic.
  • Perform lead screening for all refugee infants and children 0-16 years of age. Screen children >16 if there is a high index of suspicion or clinical signs/symptoms of lead exposure. Perform lead screening for all pregnant and lactating women and girls.
  • Eosinophilia (absolute eosinophil count >400 eosinophils/mm3) in a newly arrived refugee likely indicates a recently treated or current parasitic infection. Refer to primary care for repeat eosinophils in 3-6 months to ensure resolution. See Presumptive Treatment and Medical Screening for Parasites in Newly Arriving Refugeesfor more information.

  • Perform other general labs as appropriate per provider discretion.

    Learn more recommendations for medical screening nonspecific laboratory tests.

Tuberculosis (TB) Screening

  • Screen all refugees for TB using Interferon-gamma releaseassay (IGRA) or Tuberculin skin test (TST). IGRA is preferred for refugees 2 years and older. TST is preferred for children under 2 years old. A patient with TST must return within 48 to 72 hours to have a provider look for a reaction on the arm. 

  • BCG vaccine involved; IGRA is preferred for testing persons who have been vaccinated with BCG. Although previous BCG vaccination may influence TST results, especially in infants, a history of vaccination with BCG should not influence interpretation of TST results in adults.
  • 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 infections and active TB diseases should be referred to the local public health unit for treatment.

    Learn more recommendations for post arrival TB screening

Viral Hepatitis Screening

Routine screening for Hepatitis A, D, & E is not recommended. Testing for HDV infection is recommended for all HBsAg-positive new arrivals.Hepatitis A vaccination is recommended for children and select adults following ACIP recommendations.

Hepatitis B 

  • Screen all refugees with Hep B surface antigen (HbsAg).

  • Review overseas medical records for Hep B vaccination. For those who are unvaccinated, test for immunity by serology with Hep B surface antibody(anti-HBs) and total Hep B core antigen (anti-HBc). This will assist in determining immune status and the need for hepatitis B vaccination.
  • Refugees who do not have HBV infection and are unvaccinated or have incomplete vaccination, Hep B vaccination series should be offered according to ACIP recommendation.
  • Refer refugees with chronic Hep B infection for further evaluation and management, including testing for Hep D. See CDC tablefor interpretation and initial management guidance.
  • Hep B is a reportable disease, and cases should be reported to the state or local health department, according to state reporting requirements.
  • Note: Refugees who are partially vaccinated should complete the series, except if they are positive for anti-HBc AND anti-HBs and, thus, considered immune by infection.

      Learn more recommendations for post arrival specific viral hepatitides.

Hepatitis C 

  • Screen all refugees 18 years and older with Hep C antibody (anti-HCV). Screening for others is also encouraged.
  • Screening is recommended for all pregnant women during each pregnancy.
  • 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 HCV- positive mothers.
  • Refer refugees with Hep C infection for further evaluation and management, including vaccination for Hep A and Hep B if susceptible.
  • Hep B is a reportable disease, and cases should be reported to the state or local health department, according to state reporting requirements.

      Learn more recommendations for post arrival specific viral hepatitides.

Sexual and Reproductive Health 

  • Perform urine pregnancy tests for all women and children of childbearing age. Refer pregnant individuals for ongoing care, as appropriate. Refer to primary care to discuss family planning, if interested.

  • Syphilis Screening
    • 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.
    • Screening for others is also encouraged.
  • Gonorrhea and Chlamydia Screening
    • Screen all refugees 18 years and older if no overseas documentation is available.
    • Screen refugees 18 years and younger if there is a reason to suspect infection, or if there are risk factors.
    • Screen any refugees with abnormal vaginal or rectal discharge, intermenstrual vaginal bleeding, or lower abdominal or pelvic pain, urethral discharge, dysuria, or rectal pain or discharge.

      Learn more recommendations for post arrival screening and evaluation.

  • HIV Infection
    • Screen all refugees between 13-64 years old. Screening for others is also encouraged.

      Learn more recommendations for post arrival screening and evaluation.

Intestine Parasite Testing

  • 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.
  • See Table 1 and Table 2 for a summary of CDC’s presumptive treatment guidance.

     Learn more recommendations for post arrival screening and evaluation.

Vaccinations

  • Self-reported vaccine doses without written documentation are not acceptable.

  • Vaccine doses administered outside the United States should be accepted as valid, if schedules and doses are compatible with the ACIP guidance, Adult and Children Immunization Schedule.
  • When vaccine records are unavailable, or vaccines are incomplete, an age-appropriate vaccine schedule should be initiated following the ACIP guidance, adult and children immunization schedule. Complete any initiated series; do not restart a vaccine series.
  • Serologic testing is generally not recommended. The cost of testing may deter patients and lead to missed opportunities to vaccinate. Serologic testing for certain antigens may be considered when the clinician determines that it is in the best interest of the patient.

      Learn more recommendations for post arrival vaccine administration.

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.
  • For children with concerns for developmental delay or other behavioral health concerns, refer for further evaluation through pediatrician or primary care provider.

      Learn more recommendations for post arrival screening and evaluation.

Children 2 years and under only require CDC, TST test, and lead testing.  

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