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Washington, DC – Civil Surgeon LTBI Reporting Guidelines

Currently, the United States Citizenship and Immigration Services (USCIS) and Centers for Disease Control and Prevention (CDC) currently require that all status-adjusters over the age of two years old that are screened by Civil Surgeons receive an interferon gamma release assay (IGRA) to be screened for TB/LTBI. Furthermore, anyone with a positive IGRA, known HIV infection, or signs/symptoms of TB should have a Chest X-Ray (CXR) performed.

 As of 2018, the USCIS/CDC technical instructions for Civil Surgeons also require that all applicants with a positive IGRA are reported directly to the local health department by the Civil Surgeon performing these tests. These diagnostic tests, including the IGRA and CXR, should be ordered by the Civil Surgeon treating the applicant and not referred to the DC Department of Health.

Latent TB Infection (LTBI)


Positive IGRA

  • CXR not suggestive of TB Disease

  • No known HIV infection

  • No signs or symptoms of TB


Suspicion for Active Disease or Confirmed Disease


This definition applies if any of the following are met:

  • Abnormal CXR suggestive of TB

  • Signs or Symptoms suggestive of TB


Provider should report to the DC Department of Health within 24 hours as Class III (Confirmed TB) or a Class V (Suspected TB).
HAHSTA Case Report Form.

The I-693 may not be completed until the applicant completes an evaluation by Department of Health.

Known HIV Status


  • Applicant has a known positive HIV test/diagnosis


  • Civil Surgeon will still be required to have CXR and IGRA ordered, as well as symptom review.

  • Civil Surgeon is also required to refer patient directly to DC Department of Health for additional evaluation regardless of IGRA/CXR Results.

  •  The I-693 may not be completed until the applicant completes an evaluation by Department of Health.

Attached is a comprehensive tool kit below for your use which includes the following components:

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