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 examination of all family members and an opportunity to identify health concerns, promote well-being, orient new arrivals to the U.S. health care system, and connect individuals to ongoing care, helping them overcome barriers towards 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 primary care and specialty care if needed.
Screenings are performed by medical providers and may take up to two visits, that include:
- Review of overseas medical examination
- Assessment of current health
- A physical examination
- Lab work
- Immunizations
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.
Schedule a ScreeningOr Contact a Medical Screening Provider Near You
General Questions
How is the refugee medical screening different from an overseas medical examination?
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.
Are only refugees eligible for a refugee medical screening?
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.
What should I bring for the refugee medical screening?
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
How much does the refugee medical screening cost?
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.
How do I prepare for the refugee medical screening?
- 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.
What should you expect at the refugee medical screening?
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.
What are your rights during the refugee medical screening?
- 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.
What is the difference between a refugee medical screening and other types of visits?
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.
How do I schedule a refugee medical screening?
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.
Do the results of a refugee medical screening affect my immigration status?
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.
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. The Office of Minority Health's Think Cultural Health website provides many resources and educational opportunities for healthcare professionals to learn about culturally and linguistically appropriate services (CLAS). 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 Physical 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, head-to-toe physical exam as permitted by the patient, as this may reveal undiagnosed underlying disease and other medical issues.
- Perform vision screening if able.
Perform hearing screening if able.
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.
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. Uniting for Ukraine program doesn’t require TB testing for children under 2 years old.
- 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.
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.
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.
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.
- HIV Infection
- Screen all refugees between 13-64 years old. Screening for others is also encouraged.
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.
Vaccinations
Vaccine doses administered outside the United States should be accepted as valid, if schedules and doses are compatible with ACIP recommendations. If the patient presents with no documentation, assume he/she is not vaccinated.
- Prior to administering vaccines, evaluate any previous vaccines, if available, lab evidence of immunity, or history of the disease and use the ACIP catch-up schedule to administer for adults and children. Laboratory evidence of immunity is an acceptable alternative when previous vaccinations or disease exposure are likely.
- Administer age-appropriate vaccines only, complete any initiated series, do not restart a vaccine series.
- Vaccines are part of the USCIS’s I-693 Report of Medical Examination and Vaccination Record.
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.
Children 2 years and under only require CDC, TST test, and lead testing.