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Refugee Health Care: Understanding Terms

The following definitions are relevant to refugee health and refugee resettlement.

Adjustment of Status means the process by which certain foreign nationals in the United States apply for immigrant status. Persons may have their status changed to legal permanent resident if they are eligible to receive an immigrant visa and one is immediately available. A medical examination performed by an INS-approved civil surgeon is required as part of the application process.

Alien is a term used by the Immigration and Naturalization Service and means a person who is not a citizen or national of the United States.

Amerasian refers to certain Amerasians from Vietnam admitted to the United States as immigrants under Section 584 of the Foreign Operations, Export Financing, and Related Program Appropriations Act, 1988 (PL No.100-202) or as United States citizens, under title II of the Foreign Operations, Export Financing, and Related Program Appropriations Acts, 1989 (PL No. 100-461), 1990 (PL No. 101-167), and 1991 (PL No. 101-513).

American Council of Voluntary Agencies Form(ACVA Form) refers to the form received by the state Department of Public Health from the United States Public Health Service Quarantine Station that contains demographic and medical information on individual refugees.

Arrival Paper means the notification form received from the Quarantine Station. The paper may be an ACVA Form, Orderly Departure Program Form, Non-Indochinese Refugee Notification, or Reception and Placement Assurance Form. All contain relevant demographic information.

Asylee means a foreign national who cannot return to his or her country of origin or last residence because of persecution or the well-founded fear of persecution because of race, religion, nationality, membership in a particular social group, or political opinion, as determined by the State Department or the Immigration and Naturalization Service (INS). An asylee applies for and receives this status after entering the United States.

Centers for Disease Control and Prevention (CDC) is the federal agency responsible for promoting health and quality of life by preventing and controlling disease, injury, and disability. The Division of Quarantine is responsible for the general oversight of the medical examination process both in the United States and abroad.

Certain Amerasians
Persons from Vietnam who are admitted to the U.S. as immigrants pursuant to section 584 of the Foreign Operations, Export Financing, and Related Programs Appropriations Act, 1988, are also eligible to receive ORR assistance and services. This definition is contained in section 101(e) of Public Law 100-202 and amended by the 9 th proviso under Migration and Refugee Assistance in Title II of the Foreign Operations, Export Financing, and Related Programs Appropriations Acts, 1989 (Pub. L. No. 100-461 as amended).

Civil Surgeon means a physician approved by the Immigration and Naturalization Service district office to conduct the medical examinations of applicants for adjustment of status, or other aliens referred by the Immigration and Naturalization Service.

Class A Condition means an excludable medical condition (e.g., infectious tuberculosis, HIV infection, physical or mental disorder with associated violence that may pose a threat, drug abuse or addiction) diagnosed in a refugee during the overseas medical examination. Class A conditions require approved waivers for United States entry and require immediate follow-up.

Class B Condition means a physical or mental abnormality, disease, or disability serious in degree or permanent in nature amounting to a substantial departure from normal well-being diagnosed during the overseas medical examination. Class B designations indicate a need for follow-up soon after arrival in the United States by appropriate medical personnel.

Cuban/Haitian Entrant means a person who is granted parole status or special status under the United States immigration laws for Cubans and Haitians.

Date of Entry means the date the refugee entered the United States. For Cubans and Haitians, this is the date entrance status is granted.

Department of Justice is the federal agency that enforces federal laws. The Immigration and Naturalization Service is part of the Department of Justice and is responsible for enforcing the Immigration and Nationality Act.

Department of State is the federal agency responsible for international policies, programs and activities of the United States. The Bureau of Population, Refugees, and Migration has the responsibility of formulating policies on population, refugees, and migration, and for administering United States refugee assistance and admissions programs.

Health Screening means the comprehensive assessment of newly arrived refugees organized and overseen by the Department of Health that includes:

  • Follow-up of conditions identified overseas;
  • Evaluation and diagnostic services to determine health status and identify health problems;
  • Referral for follow-up of health problems identified;
  • Education/orientation to local health care services;
  • Linkage with primary health care services.

I-94 is the Immigration and Naturalization Service document that records each non-permanent resident alien’s arrival in, and departure from, the United States. It identifies the period of time for which the alien is admitted and the alien’s immigration status.

Immigrant means an individual admitted to the United States as a lawful permanent resident. They may be issued immigrant visas by the Department of State overseas or adjusted to permanent resident status by the Immigration and Naturalization Service in the United States.

Immigration and Nationality Act (INA) is the Act that, along with other immigration laws, treaties, and conventions of the United States, relates to the immigration, temporary admission, naturalization, or removal of aliens.

Immigration and Naturalization Service (INS) is the federal agency within the Department of Justice that administers immigration law.

International Organization for Migration (IOM) is the intergovernmental body based in Switzerland that manages refugee movements to the United States.

IOM Bag means the bag issued to refugees at the time of travel in order to carry medical and other documents, including the OF-157, immunization records and overseas chest x-rays.

Match Grant means a public/private partnership agreement between a VOLAG and the Department of State under which refugee resettlement costs are shared between the government and a community. VOLAGS that resettle refugees pursuant to Match Grants are responsible for cash and in-kind support for refugees beyond the normal 30 days in a Reception and Placement Agreement.

Nonimmigrant means a foreign national who seeks temporary entry to the United States for a specific purpose. Included in this category are persons on student, business or tourist visas. Although refugees, parolees and other specific categories of arrivals are processed as non-immigrants upon arrival to the United States, these classes are not included in nonimmigrant admission data.

OF-157 means the Department of State Optional Form 157 “Medical Examination of Applicants for United States Visas”. This form is in the possession of the arriving refugee and contains all findings from the overseas medical examination.

Office of Refugee Resettlement (ORR) is the federal office within the Department of Health and Human Services that provides for the resettlement of refugees arriving in the U.S.

Orderly Departure Program (ODP) means the program between the United Nations High Commission for Refugees (UNHCR) and Vietnam that established a legal emigration program for those seeking family reunification, or those of special interest to resettlement countries (e.g., former political detainees, Amerasians). The program was established to provide an alternative to the dangerous boat departures.

Parolee means an alien who has been given permission to enter the United States under emergency conditions or when that alien’s entry is considered to be in the public interest.

Port of Entry means any location in the United States or its territories that is designated as a port of entry for aliens and United States citizens. Refugees are (generally) limited to entering the country through those ports of entry with staffed Quarantine Stations.

Quarantine Station means the station at a major port of entry that is charged with preventing the importation and spread of communicable disease into the United States. Quarantine officers inspect arriving aliens and medical documents and forward copies of documents to appropriate health authorities in the resettlement location. Refugee arrivals are limited to the seven ports of entry where CDC has staff (Atlanta, Chicago, Honolulu, Los Angeles, Miami, New York City, San Francisco, and Seattle).

Refugee means a foreign national who cannot return to his or her country of origin or last residence because of persecution or the well-founded fear of persecution because of race, religion, nationality, membership in a particular social group, or political opinion, as determined by the Department of State or the Immigration and Naturalization Service (INS). A refugee receives this status prior to entering the United States. [The term “refugee” is defined in Section 101(a)(42) of the Immigration and Nationality Act (8 USC 1101(a)(42)).] For the purposes of the Health Assessment Program, the term “refugee” encompasses asylees as well as Cuban or Haitian Entrants. Applicants for asylum are not included except Cuban and Haitian applicants eligible under section 501 of the Refugee Education Assistance Act of 1980.

Refugee Act of 1980 refers to Public Law 96-212, enacted in 1980. The Refugee Act established a comprehensive refugee resettlement and assistance policy. It provides mechanisms for setting annual level of admissions to the United States, authorizing refugee admissions in emergency situations, and authorized, for the first time, federal assistance to resettle refugees in the United States on a uniform basis, regardless of their country of origin.

Refugee Cash Assistance (RCA) means the program of temporary cash assistance for refugees not eligible for TANF or SSI. It is funded through ORR and the period of funding is time limited by ORR, depending on availability of funds. [In 1990, the period of eligibility was set at 8 months from the date of entry.]

Refugee Medical Assistance (RMA) means the program of temporary medical assistance for refugees not eligible for Medicaid. It is funded through ORR.

Resettlement Agency (VOLAG) means a national voluntary agency, or a local affiliate or subcontractor of a national voluntary agency, that has entered into a grant, contract, or cooperative agreement with the United States Department of State or other appropriate federal agency to provide for the reception and initial placement of refugees in the United States.

Secondary Migrant means a refugee who initially settles elsewhere in the United States and subsequently moves to Rhode Island or vice versa.

Severe forms of trafficking in persons
(A) sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age; or (B) the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery.

Sponsor means the person or organization that assists an applicant in their admission to the United States.

Substance Abuse and Mental Health Services Administration (SAMHSA) is the federal agency, comprised of three centers that carry out the agency’s mission of providing substance abuse and mental health services. The Refugee Mental Health Program is within the Center for Mental Health Services.

Supplemental Security Income (SSI) means the federally funded cash assistance program for low income persons who are aged [65 years or older], blind or disabled and qualify for eligibility. Eligibility is contingent on income and provides a guaranteed minimum income based on need. Refugees, asylees, entrants, parolees, and certain other aliens may qualify for this program.

Temporary Assistance to Needy Families (TANF) means the federal-state program that provides assistance to families with dependent children who meet certain financial specifications. Refugees, asylees and entrants are exempted from the bar to receiving TANF assistance during the first five years of United States residence that is applied to qualified aliens.

Unaccompanied Minor means refugee children under the age of 18 years arrive in the United States without a guardian and are placed in foster care.

United Nations High Commission for Refugees (UNHCR) is the United Nations agency given the mandate to lead and coordinate international action for the worldwide protection of refugees and the resolution of refugee problems.

Visa Medical Examination or Overseas Medical Examination means the physical and mental examination immigrants and refugees coming to the United States complete as part of the visa application process. The purpose of the visa medical examination is to identify the presence or absence of certain disorders that could result in exclusion from the United States under the provisions of the Immigration and Nationality Act.

VOLAG means a national voluntary agency or a local affiliate responsible for initial refugee resettlement.