Reporting Instructions for Civil Surgeons

What should be reported?

Civil surgeons are required to report tuberculosis (TB) screening outcomes that result in latent TB infection (LTBI) or active TB disease to the local health department (LHD) in which their patient resides.

All reporting notifications to local TB programs should include: applicant’s name, contact information, IGRA results, chest x-ray report, and treatment results.

Visit the CTCA Directory to contact your local TB program for specific reporting or referral instructions.

Report or Refer?	Category	Definition	Note
Report	Latent TB Infection (LTBI)	Positive IGRA Chest x-ray not suggestive of TB disease No known HIV status No signs or symptoms of active TB disease	Applicants who have written documentation of completing LTBI treatment prior to the civil surgeon examination do not need be to reported.
Refer	Applicants with HIV infection	If the applicant has known HIV infection, an IGRA and chest x-ray must be performed.	Regardless of the results, the applicant must be referred to their LHD of residence for sputa collection.
Report and refer	Active TB disease (suspected or confirmed)	Abnormal chest x-ray suggestive of TB disease, regardless of symptoms Clinical signs or symptoms of suggestive TB disease Extra pulmonary disease, regardless of chest x-ray results	Any confirmed or suspected case of active TB disease is required, by law, to be reported to the applicant’s LHD of residence within one business day.

How should LTBI be reported?

All civil surgeons in the United States are now required by the Centers for Disease Control and Prevention (CDC) to use an online system called eMedical to report persons adjusting their immigration status who are found to have latent TB infection (LTBI).

We encourage you to stop using the CalREDIE Provider Portal, and to report LTBI using eMedical. Your local health department may contact you with any additional reporting instructions.

Please see the “What should be reported?” box at the left of this page for information on referring patients who need additional evaluation for TB.

Resources for eMedical reporting

CDC instructions, communications, and presentations (note that each directory in the site below has multiple files):
https://ftp.cdc.gov/pub/Civil_Surgeons/eMedical/
If you did not receive onboarding information from eMedical and CDC: OPSCivilSurgeons@uscis.dhs.gov
Help with onboarding and reporting via eMedical: CivilSurgeons@cdc.gov
Updating civil surgeon contact information: NBCCivilSurgeons@uscis.dhs.gov

How should suspected or active TB be reported and referred?

California civil surgeons should contact their local TB program for specific instructions to refer suspected or active TB disease.

Many LHDs prefer notification via phone, secure fax, or secure email, in addition to submission of a Confidential Morbidity Report (CMR).

Visit the CTCA Directory to contact your local TB program for specific reporting and referral instructions.

U.S. Citizenship and Immigration Services

Form I-693 – Report of Medical Examination and Vaccination Record