In 1997, the Virginia Refugee Health Program coordinated a protocol and reimbursement structure to encourage health departments to perform initial health screenings on refugees settling in the Commonwealth by establishing four recommended levels of assessment. This thesis is concerned with these initial health-related services provided to refugees by Virginia's health departments, the quality of these services, and how they vary from one district to another. For this study, I interviewed health department staff representing 13 of Virginia's 19 districts that rendered health screenings in 2000. Information such as the level of assessment provided, and the types of procedures and services offered were the main foci of the interviews. I found that of the 13 districts, three (the cities of Alexandria and Virginia Beach, and Prince William County) offer only the required minimum to refugees. The variations I discovered in the services that health districts provide suggest, conceptually, the workings of both "structure" and "agency." Each health department is formally and informally structured in terms of staffing, services, and resources in accordance with its individual needs and initiatives. The structure of current funding at both the state and local level acts to inhibit some health districts from providing all four levels of assessment. In addition, human agency in the form of personal interest in meeting refugee's health needs as well as district collaboration with local resettlement agencies, also plays an important role in the extent of refugee services rendered.