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Full Patient Contact

Patient Contact for Foreign Scientists at NIH

Eligibility for patient contact is determined by several factors; NIH designation, immigration status, and whether the foreign medical graduate needs full or incidental patient contact. The information below describes the policies and requirements for full or incidental patient contact broken down by NIH designation and immigration status. Consult with DIS to confirm the eligibility of a specific foreign medical graduate.

An M.D. or an equivalent degree is required to be eligible for patient contact. No level of patient contact privileges is granted without review and approval by the NIH Credentialing Services Section, Medical Records Department, and the Medical Executive Committee. Contact the NIH Credentialing Services Section if you have questions about a foreign medical graduate’s eligibility for patient contact from a credentialing perspective.

A summary of designations eligible for full patient contact can be found in our poster gallery.

NIH Patient Contact Policy by Designation

Visiting Fellows

Clinical activities of Visiting Fellows must explicitly be under the direct supervision and control of an NIH employee physician and are limited to the incidental patient contact level. 

Special Volunteers

Special Volunteers may be eligible for incidental patient contact depending on their professional credentials. 

Research Collaborators (Clinical & Non-Clinical)

Clinical Collaborators may have full patient contact privileges when they are sponsored by another U.S. medical institution and are coming to NIH for clinical research and/or rotation. Non-Clinical Collaborators may have incidental patient contact. 

FTE clinical designations (e.g., Clinical Fellows, Staff Clinicians)

FTE clinical designations must possess both the qualifying credentials and a visa classification that authorize full patient contact privileges.​

FTE non-clinical designations (e.g., Research Fellows, Staff Scientists)

FTE non-clinical designations may be eligible for incidental patient contact depending on their education history. Consult with the NIH Credentialing Services for more information.; 

Patient Contact Privileges by Immigration Classification

NIH-sponsored J-1 Exchange Visitor Program

Incidental Patient Contact: Patient contact is limited to "incidental patient contact" where the primary purpose is for research, teaching or observation. After the IC provides a four-point memo, DIS prepares an Incidental Patient Contact statement for review by the designated NIH senior medical official for signature. 

ECFMG-sponsored J-1 Exchange Visitor Program (Alien Physicians)

Full Patient Contact: J-1 Alien Physicians sponsored by the Educational Commission for Foreign Medical Graduates (ECFMG) are the only J-1 Exchange Visitors authorized to engage in full patient contact. The ECFMG sponsors eligible foreign medical graduates to participate in a clinical residency or fellowship program under the Alien Physician category of the J-1 visa. All applicants for J-1 sponsorship as Alien Physicians must hold a valid ECFMG certificate at the time they enter into a program of graduate medical education. Note: Graduates of U.S. and Canadian medical schools accredited by the Liaison Committee on Medical Education (LCME) are excluded from this requirement. See the “Requirements for Certification” page on the ECFMG website for further information. 

H-1B Temporary Alien Worker in a Specialty Occupation

Incidental Patient Contact: The alien physician must be coming to the U.S. primarily to teach and/or conduct research. No patient care may be performed except that which is incidental to the physician's teaching or research. Please see the "I-129 Worksheet". DIS requires a four-point memo for approval by the designated NIH senior medical official.; 

Full Patient Contact: An alien physician may engage in full patient contact as an H-1B Temporary Worker. The alien physician must meet and provide evidence of all of the criteria listed on the "I-129 Worksheet"

TN Professional

Incidental Patient Contact: TN status is available only to Canadian and Mexican citizens. The alien physician must be coming to the U.S. primarily to teach and/or conduct research. No patient contact may be performed, except that which is incidental to the physician's teaching or research. DIS requires a four-point memo for approval by the designated NIH senior medical official.  

O-1 Alien of Extraordinary Ability in the Sciences

Full and Incidental Patient Contact: O-1 status is reserved for Aliens of Extraordinary Ability who are among the small percentage of individuals that have risen to the very top of their field of endeavor, and who are coming to the U.S. to continue work in the area of extraordinary ability by engaging in a specific event. The level of patient contact must be described in the O-1 petition filed with USCIS by DIS. Copies of the individual's medical credentials must be included in the petition. If incidental patient contact is requested, DIS also requires a four-point memo for approval by the designated NIH senior medical official. 

J-2 (Dependent of a J-1 Exchange Visitor)

Individuals holding J-2 status may apply directly to USCIS for an Employment Authorization Document (EAD). This EAD allows for unrestricted employment, including full patient contact privileges. 

A-1/A-2 (Dependent of a foreign diplomat), G-1/G-3/G-4 ​(Dependent of an employee of an international organization)

Dependents holding A-1, A-2, G-1, G-3, or G-4 status may apply through their sponsoring international organization or diplomatic post and the Protocol Office of the Department of State under certain circumstances for each status. Dependents in A & G status should consult their sponsoring organization for more information. A & G status holders are given neither explicit patient contact permission by visa status, nor are they prohibited from having full or incidental patient contact by their visa status. The only requirement is that the individual be qualified to practice medicine in the United States. 

B-1 (Visa Temporary Visitor for Business) and WB (Visa Temporary Visitor for Business under​ Visa Waiver Program​

Patient contact is not permitted. But, see information below on "medical clerkships": 

Medical clerkship: An individual who is studying at a foreign medical school and enters the U.S. temporarily in order to take an "elective clerkship" at a U.S. medical school's hospital without remuneration from that hospital. An "elective clerkship" affords practical experience and instruction in the various disciplines of medicine under the supervision and direction of faculty physicians at a U.S. medical school's hospital as an approved part of the individual's foreign medical school education. 

Applying for Incidental Patient Contact for NIH-Sponsored Foreign Scientists

When possible, apply for incidental patient contact (IPC) to be effective at the start of the award, appointment, or assignment period. When in doubt about whether IPC will be needed to fulfill a foreign scientist's research program, apply for it.


  1. Clear explanation of the need for IPC in the "Description of Proposed Research Program" block of Form NIH 829-1 or NIH 590
  2. Copy of Educational Commission for Foreign Medical Graduates (ECFMG) certification, if applicable
  3. "Four-Point" Memorandum through the IC Clinical Director, to the designated NIH senior medical official, to outline the participant's clinical duties. The memorandum must include (a) the name of the foreign scientist to whom it refers; (b) the name of the NIH physician who will be responsible for the FMG's patient contact; and (c) address the following four points:
    • that the program in which the foreign physician will participate is predominately involved with observation, consultation, teaching, or research;
    • that the individual's research program necessitates clinical contact with patients involved in the research -- describe contact;
    • the clinical privileges which are essential to carry out the research; and
    • ​that the foreign physician (1) will not be given supervisory responsibilities nor final responsibility for the treatment or diagnosis of any patients, (2) that he or she will be supervised by a U.S. citizen or permanent resident who is licensed to practice medicine in the state of (or has a Public Health Service waiver of that requirement), and (3) that he or she will receive no credit towards medical specialty certification.

Note: A new "4-point memo" is not required for renewal of appointment if there is no change in the program or supervisor. If this is the case, specifically state so on the NIH 829-1 or NIH 590.

Revised 09/2020

DIS Info

​​​Service Hours:
9:00AM - 4:00PM ET

Non-FTE Check-In/EOD:
Monday By 11:30am (​in local time zone of lab)
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Advising Services:
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Document Pickup:
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J-1/J-2 Travel Signature Requests:​
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