3. Drug Addiction and Drug Abuse
HHS sets the medical guidelines for determining drug abuse and drug addiction. The terms are defined at 42 CFR
34.2(h) and (i). The civil surgeon will review your medical history during the medical examination and ask you
questions necessary to determine whether you are currently using any drugs or other psychoactive substances or have
used them in the past.
“Drug abuse” is “current substance use disorder or substance-induced disorder, mild,” but only with respect to
substances listed in Schedule I, II, III, IV, or V of section 202 of the Controlled Substances Act. The diagnosis is
made according to the diagnostic criteria in the most current edition of the DSM or by another authoritative source as
determined by the CDC director.
“Drug addiction” is “current substance use disorder or substance-induced disorder, moderate or severe,” but only
with respect to substances listed in Schedule I, II, III, IV, or V of section 202 of the Controlled Substances Act.
The diagnosis is made according to the diagnostic criteria in the most current edition of the DSM or by another
authoritative source as determined by the CDC director. See the CDC’s Technical Instructions for more information.
If the civil surgeon determines you have a substance-related disorder, you are not eligible to apply for a waiver unless
you are applying for adjustment of status one year after you were admitted as a refugee or granted asylum.
You will no longer be inadmissible based on drug abuse or drug addiction if, after a later medical examination by
a civil surgeon, the civil surgeon finds your drug abuse or addiction is in remission. The diagnosis of remission is
made according to the diagnostic criteria in the most current edition of the DSM or another authoritative source as
determined by the CDC director.
All applicants for adjustment of status must present documents showing they were vaccinated against a broad range of
vaccine-preventable diseases. The civil surgeon will review your vaccination history with you to determine whether you
have had all the required vaccinations. Make sure you take your vaccination records with you to your appointment with
the civil surgeon.
NOTE: Do not attempt to meet the requirements before the civil surgeon evaluates you, in case any of the required
vaccines are not medically appropriate for you.
You can find a list of the required vaccines at
If you never received certain vaccines, or you are unable to prove you received them, the civil surgeon can provide them
to you. You also have the option to ask your family doctor to administer those vaccines to you after your evaluation by
the civil surgeon. If you choose that option, show the records to the civil surgeon to note on Form I-693.
If you initially did not have documents proving you received all the required vaccines, but later submit those documents,
USCIS may grant you a waiver based on the civil surgeon’s certification on Part 9. Vaccination Record of Form I-693.
USCIS may also grant you a waiver if the civil surgeon certifies that it is not medically appropriate for you to have one or
more of the required vaccines.
HHS has determined that a vaccine is “not medically appropriate” if:
1. The vaccine is not recommended for your specific age group;
2. There is a medical reason why it would not be safe to have the vaccine (for example, you are allergic to eggs and/or
yeast or you had bad reactions to prior vaccines);
3. You are unable to complete the entire series of a required vaccine within a reasonable amount of time; or
4. For the influenza vaccine, it is not the flu season.
Form I-693 Instructions 10/19/17 N
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