Tuberculosis Immigration Clearance

CIVIL SURGEON REPORTING (I-693 Form Completion for Immigration Status Adjustment)

Reporting Instructions

As of October 1, 2018, civil surgeons (CS) are required to report latent tuberculosis infection (LTBI) to local health departments (LHDs). The CDC Division of Global Migration and Quarantine revised its Tuberculosis Technical Instructions for civil surgeons screening applicants for immigration status adjustment. Civil surgeons are required to report tuberculosis (TB) screening outcomes that result in Latent TB Infection (LTBI) diagnosis to public health departments. Please visit the CDC website in the resource library below to review the new 2018 TB Technical Instructions for Civil Surgeons.

Civil surgeons should use the CalREDIE Provider Portal system for reporting to San Mateo County Public Health TB Control Program:

• To obtain a Provider Portal account for CalREDIE, please request one through the CalREDIE Account Request Portal.
• If you are an existing user and you have questions regarding CalREDIE, please contact the CalREDIE Help Desk: call 866-866-1428 or email CalREDIEHelp@cdph.ca.gov.
• If CalREDIE is not an option, please fax Confidential Morbidity Report (CMR), Interferon Gamma Release Assay (IGRA) blood test and chest x-ray results to 650-573-2919.
• Notification to San Mateo County should include CMR, patient name, contact information, IGRA blood test and chest x-ray results.

It is crucial we receive the report as close to the exam date as possible to ensure proper follow up. Please submit the report to San Mateo County via CalREDIE or fax within 30 days of the exam.

Who Should Be Reported?

Applicants with addresses in San Mateo County who meet the following criteria have LTBI and should be reported:

• Positive IGRA result, and
• Chest X-ray not suggestive of tuberculosis disease, and
• No known HIV infection, and
• No signs or symptoms of TB disease.

Note: Do not report applicants who have written documentation of previously completing treatment for LTBI.

Additional Considerations

Applicants with San Mateo County addresses who need further evaluation and follow-up for possible active TB disease should be immediately referred (not reported) to San Mateo County. Please fax the appropriate CMR, IGRA test results, and CXR to 650-573-2919 immediately. Per the CDC technical instructions, applicants who have the following must be referred:

• Abnormal chest x-ray results suggestive of tuberculosis disease.
• Clinical signs or symptoms suggestive of tuberculosis disease or known HIV infection regardless of IGRA result or chest x-ray findings.
• Extrapulmonary disease regardless of chest x-ray results.

B-Waivers

San Mateo County residents with private health insurance will need to complete the TB Immigration Clearance Process through their primary healthcare network. Please fax the results of the follow-up and the completed TB Follow-Up Worksheet to 650-573-2919.

TB Clearance typically includes:

• TB Blood Test (IGRA) for those over two years old.
• New Chest X-ray (CXR) with comparison to the CXR completed in country of origin. The patient should have CD copy of the previous CXR.
• Sputa x 3 for AFB smear and culture if indicated based on CXR results.
• Medical Evaluation including completion of TB Follow-Up Worksheet.
• If the patient has a positive TB test and active TB has been ruled out, latent tuberculosis infection (LTBI) treatment is recommended. Preferred treatment is one of the short-course regimen options: either Rifampin daily for four months, or Isoniazid plus Rifapentine weekly for 12 weeks. If a rifamycin-based regimen is not an option (due to drug resistance or intolerance) use Isoniazid daily for nine months.

When clearance has been completed, please fax IGRA results, new chest x-ray report, sputum results (if indicated) and completed two-page TB follow-up Worksheet to 650-573-2919.

Check out the frequently asked questions about the B notification and EDN system.