Attachment C(2) 237881-B PhysicansPanelTool2

TOOL

2

LENGTH OF VALIDITY PRIOR TO TRAVEL
of Individual Sections of Medical Screening Examination, in Countries Using
the Culture and Directly Observed Therapy Tuberculosis Technical Instructions

CONDITION

LENGTH OF
VALIDITY FOR:

•• TB Evaluation
•• Syphilis
•• Hansen’s disease

LENGTH OF VALIDITY FOR:

•• History and Physical Exam
(except TB evaluation)

•• Mental and Physical Disorders

MEDICAL EXAM
DATE THAT SHOULD
BE LISTED ON
DS-2054 FORM

EXAM EXPIRATION
DATE THAT SHOULD
BE LISTED ON
DS-2054 FORM

with Associated Harmful
Behavior Assessment

•• Drug Abuse/Addiction Evaluation
•• Vaccine Assessment1

1
2

No TB Class,
No HIV Infection

6 months

1 year

TB physical
examination date

6 months from
exam date

Class A TB with
Waiver (rare)

3 months

6 months

Date final TB culture
results reported by
lab

3 months from date
final TB culture results
reported
by lab

Class A
Other than TB
No Class B1 TB
(see below)

6 months

6 months

TB physical
examination date

6 months from TB
physical exam date

Class B1 TB,
Pulmonary

3 months

6 months

Date final TB culture
3 months from date
results reported by lab final TB culture results
reported by lab

Class B1 TB,
Extrapulmonary

3 months

6 months

TB physical
examination date2

3 months from TB
physical exam date2

Class B2 TB

6 months

1 year

TB physical
examination date

6 months from TB
physical exam date

Class B3 TB

6 months

1 year

TB physical
examination date

6 months from TB
physical exam date

No TB Class,
B Other - HIV
Infection

3 months

1 year

Date final TB culture
results reported
by lab

3 months from date
final TB culture results
reported by lab

To review recent vaccination history and determine which, if any, vaccines require administration according to Technical Instructions
Unless culture of extrapulmonary TB site obtained, when “Date final TB culture results reported by lab” should be substituted

237881-B

If you have an application on your smartphone that will read QR codes, or a camera on your phone,
you can scan the code shown here to get immediate access to online content!

National Center for Emerging and Zoonotic Infectious Diseases
Division of Global Migration and Quarantine