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When navigating the complex world of immigration, the U.S. Department of State's DS-3025 form emerges as a vital piece of the puzzle, specifically focusing on vaccination documentation. Designed to be completed by a panel physician, this form documents an applicant’s vaccination status, which is a critical requirement for various visa types. With details ranging from personal identifiers, such as names and birth dates, to an in-depth vaccination history, the DS-3025 captures essential health information that influences an applicant's eligibility for a visa. The form also includes sections for blanket waivers, effectively accommodating those who may be unable to meet certain vaccination requirements due to medically valid reasons. As you make your way through the process, it's important to understand that this form not only serves the American immigration system but also safeguards public health. Panel physicians play a key role here, as they assess vaccination histories and determine whether applicants meet the health criteria prescribed by U.S. law. Proper completion and understanding of the DS-3025 can lead to smooth processing of visa applications and a step closer to fulfilling the dream of living and working in the United States.

Ds 3025 Example

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

U.S. Department of State

 

 

 

 

 

 

 

 

 

OMB No. 1405-0113

 

 

Photo

 

 

 

 

VACCINATION DOCUMENTATION WORKSHEET

EXPIRATION DATE: XX/XX/XXXX

 

 

 

 

 

ESTIMATED BURDEN: 20 minutes

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

To Be Completed by Panel Physician Only

 

 

 

 

(See Page 2 of 2)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For US Vaccination Requirements

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GIVE COPY TO APPLICANT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Surnames

 

 

 

 

 

Given Names

 

 

 

Birth Date (mm-dd-yyyy)

 

Exam Date (mm-dd-yyyy)

 

Blanket Waiver(s)

 

 

 

 

 

 

 

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To Be Requested

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

 

If Vaccination Not

 

 

 

 

 

 

 

Document Type

 

 

 

 

 

 

Document Number

 

Case or Alien Number

 

 

 

 

Medically

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appropriate.

 

 

 

 

 

 

 

 

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1. Vaccination Record

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vaccine

 

 

 

For Designated

 

Test for

 

 

ndicate reason

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

below.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Given By

 

 

 

Refugees Only:

 

Immunity

 

 

 

 

 

Vaccine History Transferred From a Written Record

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Panel

 

 

Additional Vaccine

 

Positive

 

 

 

 

 

 

 

List Chronologically from Left to Right. Provide date as mm-dd-yyyy

 

 

 

 

 

 

 

Mark all that apply

 

 

 

 

 

Site

 

 

Given by Panel Site*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(see legend):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I

 

 

 

Refugee/V93 Declines

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1A, B, C*, D, -F, H

 

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~Rotavirus

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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MenACWY Conjugate

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(specify brand in remarks)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Vaccine

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Varicella History

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pneumococcal

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Blanket waiver legend: A Not age appropriate B Insufficient time interval to complete series C* Contraindications (C1-C6, see below) D Not available in-country

 

 

F Flu vaccine not available H Known chronic hepatitis B virus infection

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Contraindications (record in blanketwaiver column): C1 Current pregnancy; C2 Immune compromised; C3 Historyof severe allergic reaction to vaccine or vaccine

 

 

component; C4 Other severe reaction to vaccine; C5 Current moderate to severe illness; C6 Other, specifyin remarks

 

 

 

 

 

 

 

 

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DS-3025

 

 

 

 

 

 

 

 

 

 

 

 

 

Please complete Page 2

 

 

 

 

 

 

 

 

 

 

 

 

Page 1 of 2

03-2020

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AILA Doc. No. 20102334. (Posted 10/26/20)

2. Vaccination Documentation (Mark one)

□

Immigrant Visa or Parolee applicant completed vaccination requirements

□ K Visa applicant voluntarily completed voccination requirements

□ Immigrant Visa applicant refused vaccination (Class A)

□ Immigrant Visa applicant requested Adoptee Exemption

□ Immigrant Visa applicant requests Individual Waiver based on religious or moral convictions

□ Refugee or follow to join Asylee/Refugee (V92/93) applicant not required to meet vaccination requirements □ K Visa applicant electing not to be vaccinated at this examination

□ Other NIV applicant not required to meet vaccination requirements

3. Panel Physician Name (printed)

I attest that I reviewed the vaccine history, ordered vaccinations, completed or supervised completion of this form, and have an agreement with the Department of State.

Panel Physician signature

Date (mm-dd-yyyy)

4. Remarks

Panel Physician Initials

Date (mm-dd-yyyy)

PAPERWORK REDUCTION ACT AND CONFIDENTIALITY STATEMENTS

PAPERWORK REDUCTION ACT STATEMENT

Public reporting burden for this collection of information is estimated to average 60 minutes per response, including time required for searching existing data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection. You do not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to: PRA_BurdenComments@state.gov

CONFIDENTIALITY STATEMENT

INA Section 222(f) provides that visa issuance and refusal records shall be considered confidential and shall be used only for the formulation, amendment, administration, or enforcement of the immigrant, nationality, and other laws of the United States. The U.S. Department of State uses the information provided on this form primarily to determine an individual’s eligibility for a U.S. visa. Certified copies of visa records may be made available to a court which certifies that the information contained in such records is needed in a case pending before the court. The information provided may also be released to federal agencies for law enforcement, counter terrorism and homeland security purposes; to Congress and courts within their sphere of jurisdiction; and to other federal agencies who may need the information to administer or enforce U.S. laws. Although furnishing this information is voluntary, individuals who fail to submit this form or who do not provide all the requested information may be denied a U.S. visa or cause processing delays.

DS-3025

Page 2 of 2

AILA Doc. No. 20102334. (Posted 10/26/20)

Get Ds 3025 PDF Form

Form Characteristics

Fact Name Details
Purpose The DS-3025 form is used to document vaccination records for individuals applying for U.S. immigrant visas or for refugee status.
Authority This form is governed under the Immigration and Nationality Act, specifically under Section 222.
Completing Authority Only a panel physician recognized by the U.S. Department of State can complete and sign this form.
Estimated Completion Time The estimated time to complete the form is approximately 20 minutes.
Confidentiality Information provided on this form is treated as confidential and is used solely for visa determination purposes.
Blanket Waivers Blanket waivers may be requested for vaccination requirements under specific conditions, such as medical contraindications.
Penalties for Non-Submission Failure to submit this form or provide complete information may result in visa denial or processing delays.

Guidelines on Utilizing Ds 3025

Filling out the DS-3025 form is an important step in the process of meeting U.S. vaccination requirements. This form should be completed accurately to avoid any delays in your immigration process. Once the form is filled out, it's typically submitted to the relevant authorities along with supporting documentation to help verify vaccination history and compliance.

  1. Begin by writing the surname and given names of the applicant at the top of the form.
  2. Input the document number and birth date in the specified fields.
  3. Record the exam date accurately using the format mm-dd-yyyy.
  4. If applicable, specify any blanket waivers to be requested for vaccinations not completed.
  5. In the vaccine history section, list the vaccinations chronologically from left to right, indicating the vaccine given, the date provided, and the name of the healthcare provider who administered it.
  6. For refugees, note any additional vaccine information required by the panel site.
  7. Check the box for any vaccinations you received, marking all that apply (like Diphtheria, Measles, and Polio).
  8. If necessary, indicate any medically appropriate reasons for not receiving vaccinations, referring to the appropriate letters (A, B, C, etc.).
  9. Complete Section 2 by selecting the appropriate status regarding vaccination documentation. This may include options like 'Immigrant Visa applicant voluntarily completed vaccination requirements.'
  10. Have the panel physician print their name, sign, and date the form at the designated section.
  11. Finally, add any remarks as necessary, and ensure the panel physician initials and dates this section as well.

What You Should Know About This Form

What is the purpose of the DS-3025 form?

The DS-3025 form, also known as the Vaccination Documentation Worksheet, is used in the U.S. immigration process to document an applicant's vaccination history. It is essential for determining if an individual meets U.S. vaccination requirements for obtaining a visa. This form must be completed by a panel physician and given to the applicant as part of their immigration examination process.

Who is responsible for filling out the DS-3025 form?

The DS-3025 form must be completed by a panel physician, who is a medical professional authorized by the U.S. Department of State. This physician reviews the applicant's previous vaccination records, assesses any additional vaccinations needed, and provides the required information on the form. The panel physician must sign and date the form to verify its accuracy.

What should I do if I have not received all required vaccinations?

If you have not received all required vaccinations, the panel physician will evaluate your situation. Depending on your circumstances, they may assist in scheduling any necessary vaccinations or may apply for a blanket waiver if appropriate. If vaccinations are not medically recommended or available, the physician will document this on the form and indicate the reasons for the waiver request.

What happens if I refuse to take a required vaccination?

Refusing to take a required vaccination can have significant consequences for your visa application. If you decline a vaccination, it will be recorded on the DS-3025 form as a refusal, which could classify you as a Class A medical inadmissibility under U.S. immigration law. This may complicate your eligibility for a visa, and it is important to discuss the implications with your panel physician and consider seeking a waiver based on moral or religious convictions if applicable.

What is the confidentiality policy regarding information from the DS-3025 form?

The information provided on the DS-3025 form is treated with confidentiality as mandated by U.S. law. Specifically, Section 222(f) of the Immigration and Nationality Act outlines that records related to visa issuance and refusal are confidential. They will only be used for the administration and enforcement of U.S. immigration laws. While the information may be shared with certain federal agencies under specific circumstances, your individual privacy is protected throughout the process.

Common mistakes

Filling out the DS-3025 form can be straightforward, but common mistakes may lead to complications. One frequent error involves incomplete vaccine history. Applicants sometimes fail to provide a complete chronological list of vaccinations received. This omission can result in delays or even denial of the visa application, as the panel physician needs a full vaccination record to assess eligibility appropriately.

Another mistake often made is the improper selection of the vaccination documentation status. Some individuals incorrectly check multiple boxes or the wrong option entirely. Each choice on the form corresponds to specific vaccination requirements and exemptions. Selecting the wrong category may confuse the reviewing authorities and result in additional questions or requests for more information.

People may also overlook the importance of correct dates on the vaccination history. The form asks for specific dates in the format of mm-dd-yyyy. Errors in the dates can lead to misinterpretation of the vaccination timeline. This detail is crucial since the validity and timing of vaccinations directly affect the eligibility for U.S. immigration.

Lastly, failing to include the panel physician's signature or proper identification information is a common pitfall. A signature from the panel physician certifying that they reviewed the vaccination history is essential. Without it, the application cannot be processed, leading to unnecessary delays. Ensure that all sections, including remarks and initials, are filled out accurately to avoid these setbacks.

Documents used along the form

The DS 3025 form is an essential document used to verify vaccination history for individuals applying for certain U.S. visas. In addition to the DS 3025, several other forms and documents are commonly used in conjunction with it to ensure a complete immigration process. Each of these documents supports the application and helps maintain accurate and comprehensive records for public health and safety. Below is a list of these documents along with brief descriptions.

  • DS-260 - Immigrant Visa Electronic Application: This is the primary application form used by individuals seeking an immigrant visa. The DS-260 collects biographical information, eligibility details, and information about the applicant's family, making it essential to the visa process.
  • DS-2019 - Certificate of Eligibility for Exchange Visitor Status: This form is used for individuals participating in J-1 Exchange Visitor programs. It provides information about the exchange program and confirms the participant’s eligibility to enter the United States.
  • I-864 - Affidavit of Support Under Section 213A of the Act: This document is submitted by a sponsor to demonstrate that they have adequate income or financial resources to support the immigrant. It ensures the sponsored immigrant will not require government assistance.
  • I-693 - Report of Medical Examination and Vaccination Record: The I-693 is used by applicants to document the results of their medical examinations and vaccination records. Panel physicians complete this form to confirm that applicants meet health-related requirements for entry into the U.S.
  • Form N-400 - Application for Naturalization: This form is for lawful permanent residents who wish to become U.S. citizens. The N-400 includes questions about residency, moral character, and civic knowledge, which are crucial for the naturalization process.

These forms and documents are vital in facilitating a smooth immigration process. Proper completion and submission of the DS 3025 along with these related documents can prevent delays or complications in the visa application and adjustment of status procedures.

Similar forms

The DS-3025 form serves an important function in the vaccination documentation process for individuals applying for U.S. visas. Here is a list of eight documents that are similar in purpose or function to the DS-3025 form:

  • Immunization Record Card: This document serves as a personal record of vaccinations received. Like the DS-3025, it summarizes immunization history and can be required for school enrollment or travel.
  • Certificate of Vaccination: Often issued by healthcare providers, this certificate provides proof of vaccination status. Similar to the DS-3025, it may be needed for entry into certain countries or public events.
  • Vaccination Schedule: This is a guideline outlining the timing and types of vaccinations recommended for different age groups. It aligns with the DS-3025’s role in ensuring that applicants meet necessary vaccination requirements.
  • Medical History Form: Typically filled out by patients, this form includes details about past medical treatments and immunizations, akin to the DS-3025, which seeks a comprehensive vaccination history.
  • Travel Health Certificate: For international travel, this document affirms that the traveler has received required vaccinations. Much like the DS-3025, it functions to ensure compliance with health regulations.
  • School Health Record: Used by educational institutions, this record tracks a student’s vaccination and overall health history. Similar to the DS-3025, it is vital for admission to schools.
  • Public Health Compliance Document: Issued by health departments, this document demonstrates compliance with mandatory vaccination laws. It serves a purpose similar to the DS-3025 by validating vaccination status for public health reasons.
  • Employment Health Clearance Form: Often required by employers, this form confirms that an employee has received necessary vaccinations. Like the DS-3025, it supports health and safety in the workplace.

Dos and Don'ts

When filling out the DS-3025 form, there are several key points to keep in mind. Below is a list of things you should and shouldn't do to ensure the process runs smoothly.

  • DO: Carefully read all instructions before starting the form.
  • DO: Complete all required sections, providing accurate and up-to-date information.
  • DO: Use clear and legible handwriting if completing the form by hand.
  • DO: Verify the vaccination history and include all relevant dates and details.
  • DO: Ensure the panel physician signs and dates the form appropriately.
  • DO: Keep a copy of the completed form for your records.
  • DO: Submit the form as directed to avoid delays in your visa application.
  • DON'T: Ignore any fields, as incomplete forms can lead to processing delays.
  • DON'T: Use white-out or any corrections on the form; errors should be neatly crossed out and corrected.
  • DON'T: Submit fake or altered vaccination documentation.
  • DON'T: Provide outdated vaccine information, as this can lead to complications.
  • DON'T: Forget to check for any additional guidelines or specific requirements for your visa category.
  • DON'T: Wait until the last minute to complete this form; allow ample time for processing.
  • DON'T: Submit the form without ensuring you have received all necessary vaccinations.

Misconceptions

Understanding the DS-3025 form is essential for applicants navigating the vaccination documentation process for U.S. immigration. Despite its importance, several misconceptions persist around its use and requirements. Here are four common misunderstandings:

  • Misconception 1: The DS-3025 form is only for refugees.

    • This is not true. While the form is essential for refugees, it also applies to various applicants, including immigrants and those seeking different visa categories. The vaccination requirements are critical for anyone applying for visas that are subject to U.S. health mandates.

  • Misconception 2: Completing the form guarantees visa approval.

    • Although the DS-3025 helps demonstrate compliance with vaccination requirements, it does not guarantee that a visa will be issued. Visa approval depends on multiple factors, including eligibility based on other regulations and documentation submitted during the application process.

  • Misconception 3: Any physician can complete the form.

    • This is misleading. Only designated panel physicians, who have agreements with the Department of State, can fill out the DS-3025. Their specialized training ensures they understand the specific vaccination requirements set forth by U.S. immigration policies.

  • Misconception 4: Applicants can bypass vaccination requirements altogether.

    • While certain exemptions exist, such as for medical or religious reasons, most applicants are expected to meet the vaccination requirements outlined on the form. Failure to comply can lead to visa delays or denials.

Key takeaways

When filling out the DS-3025 form, it's important to keep several key points in mind:

  • Purpose of the form: The DS-3025 is a Vaccination Documentation Worksheet used to support U.S. vaccination requirements for visa applicants.
  • Panel physician requirement: Only a panel physician can complete this form, ensuring that vaccination records are correctly reviewed and documented.
  • Record accuracy: Accurate and chronological listing of vaccine history is crucial. Each vaccine must be recorded with its administration date to assess compliance with requirements.
  • Consequences of incomplete submission: Failing to complete the DS-3025 form thoroughly can lead to visa application delays or denials. Make sure to include all necessary information.

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