Medical Evaluation for International Adoption


International adoption had its roots way back after the Korean War when Korean and biracial orphans were placed in the United States. Since then, Americans have adopted increasing numbers of children from Africa, Asia, Eastern Europe, and Central and South America.

However, international adoption does come with its costs. One of them is the myriad special health care needs for many of the adopted children. Studies have demonstrated incidences of physical, developmental, and mental concerns. Although these may be addressed prior to the adoption, some of these issues persist or do not become apparent until after adoption. Hence, a thorough medical evaluation is mandatory both in the adoptee’s country of origin and in the receiving country.

The medical evaluation process begins in the adoptee’s origin country, through a visit to a panel physician. Panel physicians should be designated medical doctors by the State department. Their role is providing a medical examination report, which is essential before the adoptee is issued an immigration visa. The visa medical evaluation includes:

  • physical exam,
  • vaccines,
  • screening for tuberculosis/TB, and,
  • if applicable, a blood test for syphilis.

Subsequently, another more thorough medical evaluation must be conducted right after the child enters the receiving country. This includes tests of growth, development, hearing, vision, and screenings for HIV/AIDS, hepatitis B, illnesses caused by parasites, and others.

Adoptive parents that pursue international adoption face several challenges, including the availability of the adoptees’ complete medical history. Hence, in many incidence, they only rely on the Department of State-mandated medical examinations. However, this does not guarantee that all health concerns are addressed. It is for this reason that post-placement medical evaluation is as necessary, in fact, even more than the initial one. But what exactly do both medical evaluations constitute?

INITIAL OR VISA MEDICAL EVALUATION

This medical evaluation focuses primarily on detecting certain serious infectious or contagious diseases, or medical disabilities. These are or maybe a basis for the child’s visa ineligibility. Should the panel physician or the consular officer detect any ineligibility, the parents shall be notified.

Medical Evaluation for International Adoption

Also, the consular officer will confirm that the parents are aware of the ineligibility, noted by the panel physician. However, even with ineligibility, a child may still receive a visa after the illness has been successfully treated. Otherwise, the child gets granted with waiver approved, for instance, by US Citizenship and Immigration Services (USCIS) for American parents.

Nevertheless, prospective adoptive parents should not rely on this medical examination to detect all possible medical conditions. In fact, they are encouraged to arrange an additional private medical examination if they have concerns about the child’s health.

The scope of the panel physician’s medical examination is, by law, limited. It is because its purpose is to identify persons with serious infectious or contagious diseases. It is not designed to evaluate the child’s overall health. Also, it is not designed to provide medical care and adequate information on the child’s short-term and long-term medical needs.

Usually, the Visa Medical Evaluation includes:

  • examination of vital signs and growth points
  • examination for: eyes, ears, nose and throat, extremities, heart, lungs, abdomen, lymph nodes and skin
  • a series of vaccinations for hepatitis A, hepatitis B, influenza, influenza type N (Hib), measles, meningococcal, mumps, pneumococcal, pertussis, polio rotavirus rubella, tetanus, and diphtheria toxoids, and varicella
  • a screening for tuberculosis/TB (skin test/chest x-ray examination)
  • a blood test for syphilis 

The panel physician will give the parents a sealed packet containing the medical exam forms. This shall be given to an immigration official after the adoptive parents and the adoptee’s arrival to the receiving country. Also, the adoptive parents should ask for an extra copy of the medical exam forms. This is in order to give it to the child’s medical provider in the receiving country for a succeeding medical evaluation.

Certainly, the purpose of this initial medical evaluation is to identify applicants with Class A conditions. As mentioned, children with these conditions should be treated or get a waiver before they can get a visa. 

Class A conditions include the following:

  • Tuberculosis
  • Syphilis
  • Gonorrhea
  • Hansen’s disease (leprosy) 
  • Mental Disorders (with associated harmful behavior)
  • Substance Abuse
  • Quarantinable diseases:
    • Cholera
    • Diphtheria
    • Infectious tuberculosis
    • Plague
    • Smallpox
    • Yellow fever
    • Viral hemorrhagic fevers
    • Severe acute respiratory syndromes 
    • Novel influenza (e.g. pandemic flu)
  • Diseases that are reportable as a public health emergency of international concern to the World Health Organization under the International Health Regulations of 2005:
    • Polio
    • Smallpox
    • SARS
    • Novel/pandemic influenza (flu)

However, among all the diseases that are mentioned, tuberculosis/TB is the most relevant for international adoptees. TB is a disease that are spread from person to person through the air. It’s caused by bacteria.

Also, it is considered infectious and active when the TB bacteria overcome the defenses of the body and begin to multiply. Therefore, people with active TB can easily spread TB bacteria to others. However, most TB can be treated with antibiotics. Expediently, the Center for Diseases Control and Prevention (CDC) updated in 2007 the TB technical instructions to improve TB screening.

Aside from TB, visa medical evaluation is also concerned with syphilis. To address this, a blood test is conducted by the panel physician. However, this is not routinely done for children under 15 unless there is a reason to suspect infection.

Waivers

 If a child has a Class A condition, waivers can be granted so that he or she can immigrate. The Centers for Disease Control and Prevention (CDC) will review and provide an opinion so that the receiving country may provide a final decision. In the US, the USCIS is responsible for this final decision.

To apply for a waiver, parents should keep track of the following:

1. Parents will have to complete a waiver request form (form I-601) with the receiving country’s foreign embassy. In the form, fill in a doctor who will sign the form and treat the child in the receiving country. Certainly, for children with TB, a health department in the receiving country must complete the I-601 waiver. They will tell if they will be able to treat the child. They may not agree to treat the child until they get all the medical forms about his or her case.

2. The panel physician will send the child’s medical forms to the embassy.

3. Both the I-601 and the medical forms will be sent to USCIS and CDC for review.

4. CDC will check the I-601 and medical forms to make sure they are correct and complete. Then, they will provide an opinion to USCIS or the U.S. Consulate about the case.

5. USCIS will make the final decision to approve or deny the waiver. This decision will be reported to the U.S. Consulate and CDC.

6. The U.S. Consulate will tell the parents if the waiver is granted. If so, the child will receive a visa.

FOLLOW-UP MEDICAL EVALUATION IN THE RECEIVING COUNTRY

Since the visa medical evaluation may only screen for certain diseases, it’s not a total picture of the child’s health. Thus, once the child is brought to the receiving country, the adoptive parents need to find a local medical provider. CDC encourages the child’s medical visit a few weeks after arrival. This succeeding medical evaluation will help identify the child’s any other health issues and allow for timely treatment if needed.

The child’s first medical visit to the receiving country should include:

  • examination of vital signs, growth points, and development
  • examination for: eyes, ears, nose and throat, extremities, heart, lungs, abdomen, lymph nodes and skin
  • hearing and vision tests
  • screenings for diseases such as HIV/AIDS, syphilis, hepatitis B
  • screenings for illnesses caused by parasites
  • TB Tuberculin Skin Test (TST)
  • a series of vaccines, if needed

Medical Evaluation for International Adoption

The child should get vaccines if he or she did not receive them on the initial medical examination. In line with this, parents are required to get the child vaccinated within 30 days of arrival.

Moreover, the local medical provider may also want to learn about the child’s medical history. Hence, if available, the parents should bring them to the visit. Parents should also consider visiting pediatricians, who focus on treating international adoptees. They tend to have more experience with medical conditions seen in children adopted internationally.

RELATED QUESTIONS

What should an applicant prepare for at the visa medical evaluation?

The adoptive parents must bring the child’s passport and appointment letter to the doctor during the medical examination. If not, they can also bring other photo identification. As for the results, the panel physician will send the results to the embassy directly. However, for some other countries, the panel physician will give the child his or her medical exam results. These are in a sealed envelope along with an x-ray, which the applicant must bring to the interview.

Are there any medical necessities the adoptive family should go through?

Yes. Prospective adoptive parents are strongly recommended to visit a clinic prior to the travel. The health provider must know the disease risks in the country where the adoptive parents are adopting. Also, if available, the health provider must know the medical and social histories of the adoptee. In line with this, the adoptive family should provide their immunization and medical histories. They should also inform the health provider of the season of travel, length of stay, and itinerary in the country. Moreover, family members who remain at home should be prepared with their immunizations as well.

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Eni Gordove

is a freelance writer who has a degree in Bachelor of Arts major in Political Science. She has also taken Bachelor of Laws, making her adept in domestic and international adoption regulations and processes.

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