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What Is a Medical Exemption Evaluation for Immigration? For many immigrants, the path to citizenship includes a civics and English language exam. But for some, a mental health or cognitive condition makes it especially difficult, maybe impossible, to meet these requirements. This is where a medical exemption evaluation, often referred to as an N-648 evaluation , becomes important. As a psychologist, I’m often asked what these evaluations involve and who they are for. At its c