Uscis Requirements For Examination I693 - Allcare Medical Clinic

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USCIS Requirements for I-693 Examination - Allcare Medical Clinic
148 Park Ave North, Renton, WA 98057
Thank you for having your I-693 examination with us. Please read below to provide the age-appropriate information.
Required
Vaccines Required (Subject change by USCIS)
Procedure/Comments:
Minimum
(Bring in original or photocopy of your immunization records. We
#1. This is a special examination and does
Immunization
can provide vaccines or do a blood tests for antibody level with
not replace the need for a comprehensive
if your age is..
extra charges if you are unable to find your records)
physical examination and other
1. Tetanus shot (Td) if you did not receive in last 10 years.
immunization updates from your primary
65 and Over
2. Varicella (Chicken pox) vaccine if no history of disease/immunity.
care physician.
3. Pneumonia Vaccine (1 dose)
#2. You will be tested for Syphilis if you are
4. Influenza (Flu Shot) during flu shot season
15 yrs or older. Positive test results will be
1.
Tetanus shot (Tdap/Td) if you did not receive in last (10) years.
reported to the health dept per applicable
Between
2. MMR (Measles, Mumps, Rubella) shots if born after 1956.
laws, and you will incur further expenses if
19 - 65 yrs of age
(2 doses between age 1-18 yrs or one dose as an adult)
confirmative tests are needed.
3. Varicella (Chicken pox) vaccine if no history of disease/immunity.
#3. You will given a tuberculosis skin test (if
4. Flu vaccine (during flu shot season) for 50 and over
you are 2 yrs or older) unless you have
documented proof of prior positive skin test
1. Hepatitis B vaccine series (3 doses)
or skin test is not medically appropriate due
2. Polio vaccines (minimum 3-4 doses, with last dose after 4th B.day
3. DTP (or DTaP/Td) vaccines (minimum 3-4 doses, with last
to blistering reaction to previous PPD test. A
Proof/Vaccines
dose after 4th birth day)
chest x-rays will be needed if your skin test
required for kids
4. MMR (Measles, Mumps, Rubella) vaccines. (2 doses,
is positive (5mm or more per INS). (You will
between
at least one month apart, between age 1-18 yrs)
need to return between 48-72 hours for the
6-18 yrs of age
skin test to be read by us). You may require
5. Varicella (Chicken pox) vaccine (2 doses, at least one month
(Flu shot required
additional evaluations if your chest x-ray is
apart, between age 1-18 yrs) if no history of chicken pox in past.
during flu season
6. Flu vaccine (during flu shot season) for kids 6 mo thru 18 yr)
abnormal.
(For 6 mo.-18 yr old)
( Extra Vaccines as below only for Kids 11 yr and older)
#4 Immunizations: It is important that you
7. Meningococcal vaccine for age 11 thru 18 yrs of age (1 dose)
provide us with your prior immunization
history. Immunizations play an important
8. Tdap vaccine (if last DTP/TD >5 yrs ago) (1 dose)
role in prevention of many communicable
1. Hepatitis B vaccine series (3 doses)
diseases. See the immunizations required
Proof/Vaccines
2. DTap, Polio & HIB vaccines (4 doses-last dose after 4th birth day)
on left side. We recommend that you
required for kids
3. MMR vaccines (2 doses at least 1 month apart)
follow up with your personal physician to
between
4. Varicella (Chicken pox) vaccine (2 doses at least a month apart)
complete immunization series that may be
2-5 yrs of age
5. Flu vaccine (during flu shot season) for kids 6 month thru 18 yr)
appropriate to your age.
1. Hepatitis B vaccine (starts at birth)
Clinic Use:
(Vaccines/Ig screen needed to
2. DTap, Polio & Hib vaccines (starts at 2 month age)
complete I-693 paper work & other notes:
Proof/Vaccines
3. MMR vaccines (starts after 1st birthday)
required for kids
4. Varicella (Chicken pox) vaccine (starts after 1st birthday)
less than 2 yrs of
5. Rotavirus vaccine (oral) (Only for infants 6 - 32 weeks of age)
age
6 Pneumonia vaccine (for age 2 months thru 24 months)
7. Hepatitis A vaccine (only for kids 12 thru 23 months of age)
8. Flu vaccine (during flu shot season for kids 6 mo thru 18 yrs)
FOR CHILDREN, their age will determine what vaccines & how many doses he/she
should have received by now. Bring in all of your immunization records for our doctor to
review. We can provide/recommend any missing doses for us to complete your medical
exam & paperwork. Additional doses/series can be completed later with your own
doctor.
I understand the information presented as above and the dates and documents
provided by me are legitimate.
Patient Name:____________________________________ DOB: _____________
Immunization documents/history reviewed by:
(Documents to be returned to patient)
Pt/Guardian’ s Signature: X________________________ Date:_____________
Physician/Provider’s Signature & date:
Interpreter’s signature:____________________________ Date:_____________
X ___________________________________
USCIS Requirements for I-693 Examination, Rev 06-2014

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