Immigration Medical Examination And Admissibility Conditions

US Immigration laws stipulate that a medical physical exam is required for all immigration visas and even for some non immigration visas. Refugees and applicants who have filed for adjustment status also need to go in for the immigration medical exam, which is also known as the Green Card Physical Examination. The main reason behind administering the Green Card Physical is to explore possibilities of any health conditions that could prevent the applicant from immigrating.


USCIS-approved Civil Surgeons are specially designated and can administer the examination inside the country. Panel Physicians can run the exam outside of the country.

All medical conditions, as per CDC norms are classified into Class A and Class B categories.

If medical conditions of the applicant fall under Class A then the applicant cannot gain admission into the country.

4 conditions that would make the applicant inadmissible on the basis of medical health are:

Those people who have any form of communicable disease that could cause concern to public health like: chancroid, gonorrhea, HIV/AIDS, leprosy (infectious), infectious syphilis, infectious TB (Class A TB) and any other communicable disease of public significance.

Those applicants who have to apply for immigrant visas or file for adjustment of status but have not received all the vaccinations as mandated by CDC.

Those people who display physical or mental anomalies, these disorders could also be associated with harmful behavior. There could be physical or mental disorders which could have existed in the past though these disorders are not current in the present they are likely to recur in the future and might even lead to harmful behavior. Such conditions could lead to the visa being refused.

Individuals who are found to be abusers of drugs. Drug addicts too could fall under the scanner.

All other medical conditions fall under Class B. Medical conditions falling under Class B also involve physical and mental conditions, certain diseases and other disabilities of serious or permanent nature. Class B category diseases could entertain waivers that could be applied for by applicants.


It would not help the applicant very much if he or she is tense or nervous before taking the examination. It is very natural for all of us to feel a bit apprehensive, especially about the results of any examination, but it could reflect in the outcome ultimately, if the applicant is tense. So it is best to stay calm and collected before the exam is due.

Choosing a Pediatric Specialty Specific Electronic Medical Record (EMR)

Is a Pediatric electronic medical record system most appropriate for your office?

An EHR / EMR that has been designed specifically for Pediatricians will have a variety of Pediatric specific content as well as Pediatric specific work flow included within the product.

It is beneficial during the initial steps of selecting and throughout the eventual implementation of an EHR/EMR product to gather any forms, communication tools, and educational material. This set of forms will assist in assuring a similar tool will be available and/or developed either by template or reporting.

The EMR / EHR has the potential to streamline work processes and have a positive impact upon office efficiency and quality. To gain the most with the implementation of the EMR / EHR it is important to look at work flow redesign. Look at potential bottlenecks or inefficient processes in the paper chart environment and rather than duplicate these inefficient processes look for the opportunity to complete a work redesign. It may be tempting to put the work redesign on a to do list but closely consider work redesign to be a part of the implementation phase. This method is usually less costly and does not require another implementation phase going forward. Pediatric Specific EMR/EHR features:

* Intake forms
* Demographics that support various family structures
* Well child / Preventative
* Immunization administration and management
* Growth Charts
* Genetic information, maintenance, and reporting
* School Physical
* Sports Physical
* Camp Physical
* Daycare Physical
* Reportable Communicable Disease management
* Child abuse reporting forms
* Referral entry and tracking
* Medication orders, tracking, and maintenance
* VIS (Vaccine Information Sheet)
* CDC link
* Flack Pain scale
* Behavioral tools
* ADD/HD tools
* Age Specific
* Birth Data
* Instrumentation integration (vital signs, EKG, spirometry, etc
* Pediatric protocols for pediatric triage
* Patient Portals
* Pediatric Specific templates

Intake Forms

Patient intake forms should be developed to flow nicely with the template work flows. The system should be set up to allow for preloading of the patient intake form prior to the visit to enhance physician schedule efficiency. Demographics That Support Various Family Structures

Demographics that support various family structures including adoption, step-children, foster care, child abuse, and single parent homes is valuable with a diverse population. It is highly recommended the Pediatric EMR//EHR capture and protect sensitive childcare information. Birth Data

Birth data sections should contain appropriate fields for birth weight, complications at birth, time and date of birth provided to facilitate documentation. All components of the EMR should address appropriate age specific criteria. Immunization Management

Immunization administration and management is a necessary component of the Pediatric EMR / EHR. The recommended immunization schedule should be a component of the EMR enabling alerts for vaccinations due at the time of a visit and an automation of reminder letters. A direct link to CDC allows easy access to the recommended vaccination schedule and ability to print VIS (vaccine information sheets) at the time of vaccine administration or prior to scheduling immunizations.

Printing the VIS form should automatically document the fact the VIS for a particular immunization was printed for specific patient as required. The most efficient systems will accommodate obtaining any parental authorizations required in the exam room preferably electronically. If electronic signature is not available the minimal acceptable method would be obtaining a paper authorization and then scanning to the visit. Immunization orders or templates should include all data required for administration of the immunization including lot number, site given, and documentation of any reaction.

Growth Charting

Growth charts that accommodate preterm, infant, and child growth records should be available for the EMR. Height, weight and other parameters to be measured should be easy to enter and then automatically plotted on the growth charts. Genetic Information, Management and Reporting

A method to document genetic information that facilitates updating and maintenance can prove very beneficial. Reporting capability from the established data fields is recommended. School, Sports, Camp, and Day care Physicals

Templates to capture the needed information for the school, sports, camp and daycare physical visit should be available for customization. Producing a form using the data in the template fields and/or information stored in various sections of the EMR is highly recommended. This will save valuable pediatrician time by not having to fill out forms manually. Contact your local schools and/or state educational offices to obtain approval of any computer generated form prior to use. The process to get the automated form approved by the proper school and/or state officials can take a considerable amount of time. Reportable Communicable Diseases Management

Identification of reportable communicable diseases can be facilitated with a link to state health departments and the CDC. Referral request Management

Referral request order entry allows for tracking of all referrals from order to consult or result received. This is a liability limiting process and can result in liability insurance cost savings to the provider. Medication Management

Medications prescribing information offering dosing assistance to the pediatrician that is age and weight based can save time and reduce risk of medication errors. A system that facilitates tracking of refills enhances care and alerts to the pediatrician to allergies, reactions, and medication conflicts in general. E-prescription is of importance to meet compliance with state and federal regulations. Laboratory Management

Laboratory fields, data and work flows that allows for easy entry of orders, results and tracking ability are vital to meeting liability concerns and maintaining compliance and quality care. Ability to scan results, consults, performed outside of the facility would be necessary to capture all data in the EMR. Pain Scale Management

Inclusion of a standard pain scale for pediatrics assures compliance with regulations laws and patient rights. There are various pain scales including those for children under age 1 and those over age 1. These include NIPS, PPP, Riley, FLACC, Cries, Faces, Oucher, and others. Behavioral Health, ADHD, AUTISM management

Data fields complementing behavioral assessments for ADHD, Autism, and other behavioral conditions should be included the EMR/EHR system. Pediatric Triage Management

To enhance and facilitate established standards of care appropriate knowledge based pediatric triage material should be built into the system or accessed via a link to the appropriate website. This will improve the phone call conduct within the office. Report, Form, Questionnaire Generator

Patient data is all in the Pediatric EMR and you need the information out for various reporting and submission purposes. A report, form and questionnaire generator will accomplish this necessary task for you. Capture the necessary information at the time of the visits and then request the appropriate report, form or questionnaire to automate this process without double entry and/or handwriting the forms. This includes school physical, sports physical, camp physical, and other forms needed for a specific visit. Document Manager and Photo Manager

There is a growing trend to capture photos of patients for inclusion in the patient record. The photo manager can provide for capture of retention of these images.

The document manager would accommodate any forms needed for the Pediatric practice, HEDIS reporting forms, etc. Pediatric EMR / EHR Templates

Pediatric specific templates developed with the Pediatricians most efficient work flow will prove to be cost efficient. A partial list of suggested EMR templates for the Pediatric Practice EMR is noted below.

* Food Allergy
* Chest Pain
* Correspondence (food allergy letters, metered dose inhaler note, school excuse)
* Ears – Drainage, infection, ear pain, ear pressure, recurrent ear infections, and many more
* Conjunctivitis
* Fever
* Infant Fever
* Abdominal Pain
* Appendicitis
* Constipation
* Reflux
* Vomiting/Diarrhea
* Circumcision
* Voice/Speech Disorder
* Throat Infections
* Miscellaneous – anaphylaxis, adverse drug reaction, child abuse, juvenile dermatomyositis, sports physical, and more
* Musculoskeletal – ankle sprain, elbow injury, foot pain, knee injury, shoulder injury, low back pain, and more
* Postnasal drainage
* Nasal Foreign Body
* Nasal Obstruction
* Headaches
* Newborn Visit
* Asthma
* Cystic Fibrosis
* Croup
* Upper Respiratory
* Allergic Rhinitis
* Sinus Infection, Sinusitis
* Skin – acne, atopic dermatitis, burns, insect bites, impetigo, rash, and more
* Viral Infections – Chicken pox, fifth’s disease, influenza, roseola, mononucleosis, and more

Patient Portals

Patient portals allow providers to grant patient access using a secure username and password to information in the EMR through a web connection. Access often is granted for the following:

* Check appointment schedules
* Request an appointment
* Review lab results
* Review statements
* Request a prescription refill
* Complete new patient intake forms.

General Considerations

All templates should be customizable. This can include making links available to CDC and state agencies. Reporting should also be customized that meets requirements for HIPAA reporting, immunization reporting, and various administrative reporting.

An EMR that allows for multiple methods of entry into the EMR is optimal to facilitate various work flows. Methods could include templates, down drop list, expandable text, voice recognition, transcription, handwritten electronic pen/pad, abstraction, and scanning.

In summary, selecting an EMR product for the Pediatric office which addresses the specific work flow and care components unique for the Pediatric patient demographics will provide the most efficiency for the Pediatric office. A Pediatric EMR specific feature check list would be a beneficial tool during the Pediatric office EMR selection process.

For more information please visit to see other specialty specific articles.

Physical Therapist Work – Facts From the Medical Staffing Office

Working as a physical therapist or physical therapist assistant, you already know the impact you have on the lives your job brings you into contact with on a daily basis. Seeing lives transformed back to a point of health, function, and strength rewards you in a way words often elude. Moreover, as rewarding as this work is it’s still a professional career path. A path requiring a lifelong education of continual exposure to trusted techniques, methods, and the latest practices. If you are looking to grow in your career, then a medical staffing office is a solid starting point for consideration.

A government report stated that in 2005 “temporary or contract job positions accounted for 20% of the current job market.” Today, with a tumultuous job-climate and technology making it easier to access job postings experts believe these types of positions will account for nearly 40% of the available jobs by 2011. And though stats like this can be a little daunting, it really does open-up the career potential for a focused physical therapist or physical therapists assistant thinking about their own future.

Here are some myths and facts regarding medical staffing agencies for consideration:

MYTH: Medical staffing firms only offer temporary jobs.

• Fact: Although there are plenty of short-term job opportunities in today physical therapy and therapy assistant careers, many staffing firms offer permanent hire positions as well. Communicating with your medical staffing recruiter what you are looking for from a job is essential to your own planning.

MYTH: A medical staffing office wont cover my travel expenses or costs of living

• Fact: Today nearly all staffing firms cover the therapist’s travel expenses. Staffing firms cover these items in the agreement with the medical provider and come at no expense to the therapist whatsoever. Paying for your travel expenses is an industry standard today. Additionally, per Diem to cover the costs of daily living while on location is equally a common practice. If you find a firm that will not pay your travel expenses or cost of living expenses – find another agency!

MYTH: Medical staffing offices lack industry knowledge of my career field

• Fact: With all the health care and provider requirement changes going on today, medical staffing offices might just be the most up-to-date source you can access daily. A great staffing firm is in constant contact with their providers to ensure they provide them with the best-trained and prepared employee base possible. Due to the high demand and fluctuating job market, the criteria that providers are looking for is often very specific and continually changing. Medical staffing offices are prime source of industry demands and requirements.

MYTH: Medical staffing offices will limit my career portfolio

• Fact: Collaborating with a medical staffing firm might just be the best career move you can make. Not only can it provide you with consistent work, but also the continual exposure to new teams, providers, and the latest industry developments can only enhance your resume.

MYTH: Medical staffing offices will not provide me with health insurance

• Fact: Many staffing firms do offer their employees health insurance as part of an employees benefits package. However, this is contingent on how the therapist-to-staffing firm relationship is defined. If you are listed as a “contractor” (IRS Form 1099), then you will most likely be required to secure your own form of health insurance. If you are listed as an employee (W-2) of the staffing firm, then you can be offered the opportunity to be apart of the company’s health insurance plan. This is something that requires research and asking questions of the agency. There are staffing firms out there that do provide health insurance; you just have to do your homework to find them.

As you look to your own professional development in physical therapy, understanding what you expect and need from your career is critical. Medical staffing offices can play a key role in seeing meet your expectations and reap real career rewards that continue to advance you in the physical therapy and therapy assistant field.

Physical Therapy Assistant Colleges and Programs

With the recent rise in healthcare related jobs, one that is projected to continue for quite a few years to come, becoming a physical therapy assistant can be a great career path for many.

It is a hand-on job that those who enjoy working directly with the public will probably enjoy, and a highly valued position to the medical facilities in need of assistants. As with any course of study though, understanding what to expect in regard to schooling and job offerings afterward is an important part of deciding whether or not this course of study is for you; learning about physical therapy assistant colleges and programs should give a good idea on whether or not this seems like the right profession to become involved in.

Types of Physical Therapy Assistant Colleges and Programs that Are Available

As with many of the different assistant and technician jobs in the medical field today, there are a few different kinds of learning programs available to those who want to become employed in the field of physical therapy, though there are distinct differences in the titles received with different training.

Those who attend short training courses that typically last a number of months, and get much of their training through hands on experience are generally employed as a physical therapy aide, which is a wonderful profession in its own, but quite different than becoming a PTA.

With the lesser educational requirements, aides typically have much lower responsibility, as well as little patient contact and lower salary.

On the other hand, those in study to become a physical therapy assistant are required to attend courses to obtain their Associates’ in Applied Science degree for Physical Therapy.

Once they have reached this goal, students earn the title of Physical Therapy Assistant (PTA), and are able to apply for licensure in their state. License to practice as a PTA is required in 48 of 50 US states today.

What is ironic is that in the UK, where in most cases assistants and technicians involved in healthcare have considerably more strict requirements and qualifications, a person may be employed as a physiotherapy assistant without schooling other than the necessary GCSEs. There are specialist positions available, which do require continued education and work experience, however.

PTA Colleges and Course Information

College courses that award students with the title of PTA and qualify them to apply for state licensure cover many different topics related to the medical field, not just classes directly related to therapy.

It is important for students to be well rounded in general, as well as understand the entire workings of the human body, and the healthcare business as it relates to physical therapy and the many different job settings a PTA might work in. Standard study topics include courses in English, Social Sciences, Psychology and Communication.

Specialized classes generally include Anatomy, Physical Therapy, Kinesiology, Pathophysiology, Rehabilitation, First Aid/CPR, Massage, electrical stimulation, ultrasound and other therapeutic treatments and many other, more specialized topics.

Additionally, in order to graduate and earn their PTA, students must fulfill a required amount of externship hours; in most Associates’ degree programs students participate in on the job work-study during the last two to three semesters of their education.

Including these externships, graduating with a PTA usually takes an average of 20 months in the US today. Professional organizations in the medical industry report that there is a push to change educational requirements for physical therapy assistants to a 4-year Bachelors degree in the future, too.

Though it may seem like a long time, earning a 2-year Associates’ degree it is the best way to enter this type of medical field. Having any degree at all is preferable to simply attending vocational classes, besides the fact that with that head start, it is easy for a PTA to continue education to become a licensed physical therapist, or even enter a different medical profession.

The word “assistant” should not fool anyone into thinking the position is not an important and demanding, however. Physical therapy assistants are required to perform and track all prescribed therapy, and actually spend more time with the patient than the therapist does.

Knowing this, attending the most reputable physical therapy assistant colleges is the best way to get the necessary education, pass the licensing exam and move on to a most rewarding lifetime career.

Physical Therapy, Pain Medications or Surgery – What Would You Choose?

You have power. The power of choice. The power to heal.

No Prescription Necessary

Did you know that in most states, including North Carolina, you can see a physical therapist directly, with out a referral from a physician? Did you also know that physical therapy is a great alternative to pain medications?

Eliminating Pain without Medication

Many types of pain and inflammation can be reduced with the help of a physical therapist, including low back pain, neck pain, bursitis, sciatica, arthritis, tennis elbow, and knee pain.

If you are at risk of heart disease, the American Heart Association encourages seeing a physical therapist for the initial treatment of pain resulting from tendinitis/bursitis, degenerative joint problems (osteoarthritis), and inflammatory joint problems (rheumatoid arthritis), rather than prescription pain medication. Physical therapists are a great alternative to medication and surgery for musculoskeletal pain. Research shows individuals who receive active physical therapy experience greater improvements in function and decreased pain intensity.

Lower back pain affects up to 80 percent of Americans during their lifetime. Physical therapy that mobilizes the spine along with specific exercises can help alleviate the pain and can have long-lasting effects. In one study manual physical therapy helped 92% of patients with lower back pain. The best thing you can do if you have pain is to continue with all your normal daily activities, work and exercise.

Please be sure not to push or exercise through any sharp or shooting pain. I have posted some videos on YouTube that may help you, especially if you need relief from low back pain.

No matter what part of your body hurts, neck, back, knee, hip, shoulder, arms, hands or head, you can alleviate or manage pain without costly medication or other invasive methods such as surgery.

Finding a Physical Therapist

In many states, including North Carolina, you can see your physical therapist directly, without a referral from your physician. This is called Direct Access, and allows you to seek treatment for your condition today, get better faster, spend less money, feel great and return to the activities you enjoy.

Physical Therapists are licensed by the state in which they practice and have completed extensive and specialized, post graduate level, accredited physical therapist education programs. They are trained in identifying red flags (signs that your condition is not appropriate for physical therapy) and know when to refer you to the appropriate health care practitioner or physician. When you visit your physical therapist, you will experience the care of a trusted health professional that uses research and proven treatments to help you regain independence and a better quality of life.

For more information on how physical therapy can help you reduce pain, avoid surgery and feel great please visit our website. When you call the physical therapy practice of your choice, ask if they provide hands-on manual physical therapy.