Individuals applying for TN visa status under certain occupations in the health care field may have to obtain a Health Care Worker certificate (visa screen) before they are able to obtain TN visa status.  

Health Care Worker Certifications

  • A foreign citizen who seeks admission to the United States for the primary purpose of performing labor as a health care worker, other than a physician, is inadmissible to the U.S. unless he or she presents the requisite Health Care Worker certificate. INA § 212(a)(5)(c).

The Health Care Worker Certificate Verifies That:

  • The individual’s education, training, license, and experience meets all applicable statutory and regulatory requirements for entry into the applicable health care profession; are comparable with that required for an American health-care worker; and are authentic and, in the case of a license, unencumbered;

  • The individual has an acceptable level of competence in oral and written English as shown by an appropriate score on one or more nationally recognized standardized tests; and

  • If a majority of States licensing the applicable profession recognizes a test predicting the success on the profession’s licensing or certification examination, the individual has passed such a test, or has passed such an examination.

Health Care Occupations Requiring Certification

The Health Care Worker Certification is required for all individuals who are entering the U.S. for the primary purpose of performing labor as a health care worker. Most health care workers affected will be applying under the H-1B, H-1C, J, O, and TN visa classifications. The health care occupations requiring certification are below (affected TN categories highlighted):

Health Care Certifications Not Required

  • Physicians: The Health Care Certification requirement does not apply to Physicians.

  • Non-clinical health care occupations: The Health Care Certification is not required for individuals who will perform services in a non-clinical health care occupation. A non-clinical care occupation is one in which the individual is not required to perform direct or indirect patient care. Such occupations include medical teachers, medical researchers, and managers of health care facilities.

  • Trainees: Individuals entering the U.S. to receive training, such as an F-1 student or H-3 trainee receiving practical training, or a J-1 trainee coming to undertake a training program in a medical field, are not required to obtain the Health Care Worker certification.

  • The spouse and dependent children of an individual subject to the Health Care Worker certification requirement are not required to obtain the certification.

  • An individual who works as a health care worker and who is being sponsored for a green card based on a family relationship does not need to present a Health Care Certification as part of his/her green card application. See 9 FAM 302.1-7 (B) (4).

Organizations Authorized to Issue the Health Care Worker Certification

  • The Commission on Graduates of Foreign Nursing Schools (“CGFNS”) is authorized to issue health care worker certificates for all seven occupations.

  • The National Board for Certification in Occupational Therapy (“NBCOT”) is authorized to issue certificates for occupational therapists only.

  • The Foreign Credentialing Commission on Physical Therapy (“FCCPT”) is authorized to issue certificates for physical therapists only.

Alternative Certified Statements for Nurses

Nurses who obtain a certified statement evidencing the satisfaction of the following requirements do not need to comply with the educational comparability review or English language requirements.

  • The individual has a valid and unrestricted license as a nurse in a state where he or she intends to be employed;

  • The individual has passed the National Council Licensure Examination for registered nurses (NCLEX-RN);

  • The individual is a graduate of a nursing program in which the language of instruction was English;

  • The nursing program was located in Australia, Canada (except Quebec), Ireland, New Zealand, South Africa, the United Kingdom, or the United States; or in any other designated country by CGFNS; and

  • The nursing program was in operation on or before November 12, 1999, or has been subsequently approved by CGFNS. INA § 212 (r).

Streamlined Certification Process

The following individuals are exempt from the educational comparability review and English language proficiency testing requirements:

  • Nurses. A nurse who has graduated from an entry level program accredited by the National League for Nursing Accreditation Commission (NLNAC) or the Commission on Collegiate Nursing Education (CCNE).

  • Occupational Therapists. An occupational therapist who has graduated from a program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) of the American Occupational Therapy Association (AOTA).

  • Physical Therapists. A physical therapist who has graduated from a program accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE) of the American Physical Therapy Association (APTA).

  • Speech Language Pathologists and Audiologists. A speech language pathologists and/or audiologist who has graduated from a program accredited by the Council on Academic Accreditation in Audiology and Speech Language Pathology (CAA) of the American Speech-Language-Hearing Association (ASHA).

Exemptions to the English Language Requirement

As part of the Health Care Worker Certification process, each individual must meet certain English language requirements in order to obtain the certificate. There are two exemptions to this English language requirement:

  • Nurses who obtain the above alternative certified statement from the CGFNS; and

  • Individuals who have graduated from a college, university, or professional training school located in Australia, Canada (except Quebec), Ireland, New Zealand, the United Kingdom, or the United States.

Validity of Certification

  • The Health Care Worker Certificate is valid for 5 years, and must be renewed in order to be re-admitted to the U.S. under TN status, or apply for a new TN visa. USCIS, Health Care Worker Certificate (citing 8 C.F.R. 212.15(n)(4)).

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Revised Aug. 18, 2018