For foreign nationals in the United States applying for a green card through adjustment of status, one of the critical steps in the process involves undergoing a medical examination and submitting Form I-693, officially titled “Report of Medical Examination and Vaccination Record.” This form, mandated by U.S. Citizenship and Immigration Services (USCIS), is required to ensure that the applicant is not inadmissible to the U.S. on public health grounds. The I-693 medical examination is a comprehensive review of the applicant’s health history, physical condition, and immunization records, performed by a USCIS-designated civil surgeon. This guide explains the purpose of Form I-693, what it entails, how to prepare for the exam, where to find a civil surgeon, how USCIS evaluates medical results, and best practices to avoid delays or denials in your adjustment of status application.
What Is USCIS Form I-693 and Why Is It Required?
Form I-693 serves to verify that applicants for lawful permanent residence (a green card) meet the health-related standards set by U.S. immigration law. Section 212(a)(1) of the Immigration and Nationality Act (INA) outlines specific medical conditions that could make an applicant inadmissible. The I-693 form is the official document used by USCIS to determine whether an applicant falls within any of these categories. The form must be completed and signed by a licensed civil surgeon authorized by USCIS. Without a valid Form I-693, USCIS cannot approve an application for adjustment of status under Form I-485. For more information, see https://www.uscis.gov/i-693.
When to Submit Form I-693
Applicants may submit Form I-693 in one of two ways:
- Concurrent Filing: Submit Form I-693 at the same time as Form I-485, the Application to Register Permanent Residence or Adjust Status.
- Later Submission: Wait for USCIS to request the form via a Request for Evidence (RFE) or bring the sealed envelope to the green card interview.
Submitting the I-693 concurrently with your I-485 can speed up processing times. However, some applicants prefer to wait in case USCIS requests updated documentation closer to the interview date. The medical exam is valid for up to 2 years after the civil surgeon signs it, provided the form was submitted to USCIS within 60 days of the signature date.
What the Medical Examination Covers
The USCIS medical exam includes several components, aimed at determining whether the applicant has any communicable diseases of public health significance, physical or mental disorders, substance abuse issues, or lacks required vaccinations. Specifically, the medical exam involves:
- Physical and mental health examination
- Screening for communicable diseases, including tuberculosis, syphilis, and gonorrhea
- Immunization record review to ensure required vaccines are up-to-date
- Drug and alcohol abuse screening
- Assessment of mental health and behavior, particularly if there’s a history of harmful behavior
The civil surgeon will complete the relevant sections of Form I-693, including the vaccination record, and place it in a sealed envelope for submission to USCIS.
Finding a USCIS-Designated Civil Surgeon
Only a USCIS-approved civil surgeon can conduct the immigration medical exam and complete Form I-693. To find one in your area:
- Use the USCIS Civil Surgeon Locator
- Contact your local USCIS field office for recommendations
- Ask immigration attorneys or community health centers for referrals
Note that fees for the medical exam vary widely and are set by each doctor. It’s advisable to call multiple clinics to compare pricing and confirm whether laboratory tests and vaccinations are included in the quoted fee.
Required Vaccinations for Green Card Applicants
USCIS requires that adjustment of status applicants receive a series of vaccinations, based on guidelines from the Centers for Disease Control and Prevention (CDC). These may include:
- Measles, mumps, and rubella (MMR)
- Hepatitis A and B
- Tetanus and diphtheria (Td/Tdap)
- Varicella (chickenpox)
- Influenza (during flu season)
- Meningococcal
- COVID-19 (must be fully vaccinated unless exempt)
You must provide immunization records to the civil surgeon, who will document which vaccinations are complete and which are not medically appropriate (e.g., due to pregnancy, allergy, or age). If vaccinations are missing, the doctor may administer them or refer you to a provider before completing the form. Additional details are available at the CDC’s immigration vaccination requirements page
Documents to Bring to the Medical Exam
Before your appointment, gather the following:
- Government-issued ID (passport or driver’s license)
- Form I-693 (blank, do not sign until instructed)
- Previous vaccination or immunization records
- Medical history, including current medications and diagnoses
- Copies of diagnostic tests (e.g., chest X-ray, TB test results)
- Insurance card (if applicable and accepted by the clinic)
Make sure you disclose all relevant medical history honestly. Failure to disclose past drug use, treatment for mental health conditions, or communicable diseases can result in denial of your adjustment application.
What Happens During the Exam
The medical exam typically includes the following steps:
- Initial Intake: Verification of identity and collection of medical history.
- Physical Exam: Basic assessment of vitals, physical condition, and visual observation of any health concerns.
- Lab Tests: Required blood and urine tests, including testing for syphilis, gonorrhea, and tuberculosis.
- Vaccination Update: Review and administration of missing immunizations.
- Form Completion: The civil surgeon fills out and signs Form I-693 and seals it in an envelope.
Do not open the sealed envelope—USCIS will only accept unopened forms directly from the doctor or the applicant. You may ask for a copy of the completed form for your records.
Common Medical Grounds of Inadmissibility
Certain health conditions can result in a finding of inadmissibility, including:
- Communicable diseases of public health significance, such as active tuberculosis or untreated syphilis.
- Physical or mental disorders with associated harmful behavior.
- Drug abuse or addiction, especially recent use or a history of rehabilitation.
Applicants found inadmissible may still qualify for a waiver of inadmissibility, depending on the circumstances. Waivers are handled through Form I-601 and must be adjudicated by USCIS. More about health-related inadmissibility and waivers is available at https://www.uscis.gov/policy-manual/volume-8-part-b.
Tips for a Smooth I-693 Process
To avoid delays or rejection of your Form I-693:
- Schedule your exam early but within 60 days of I-485 filing if submitting concurrently.
- Double-check that the doctor is a USCIS-approved civil surgeon.
- Bring original vaccination records and have them translated if not in English.
- Ask the civil surgeon to provide a copy of your completed I-693 before sealing it.
- Submit the sealed envelope with your I-485 or in response to an RFE.
- Check USCIS processing times and interview scheduling expectations for your field office
Special Cases and Waivers
Certain categories of applicants may receive waivers or exceptions:
- Religious objections to vaccinations may be waived if properly documented.
- Medical contraindications, such as allergies or pregnancy, may exempt applicants from certain vaccines.
- Children under a certain age may be exempt from specific testing requirements.
These exemptions must be documented clearly by the civil surgeon and noted on Form I-693.
How USCIS Reviews Form I-693
After USCIS receives your sealed I-693, it will be reviewed by a USCIS officer as part of your adjustment of status application. If the form is incomplete, expired, or inconsistent with other parts of your application, you may receive a Request for Evidence (RFE) or Notice of Intent to Deny (NOID). A complete, valid I-693 generally speeds up adjudication of your green card. USCIS updated its policy in 2021 to extend the validity period of Form I-693 to 2 years from the date of submission, provided it was signed no more than 60 days before filing Form I-485.
COVID-19 Vaccine Requirement
As of October 1, 2021, COVID-19 vaccination is required for all green card applicants undergoing the immigration medical exam. Applicants must be fully vaccinated with an FDA-approved or WHO-listed COVID-19 vaccine. Exemptions include:
- Age (under 6 months)
- Medical contraindications
- Unavailability in the applicant’s country or region
Proof of vaccination must be presented to the civil surgeon. Full guidance on COVID-19 vaccination for immigration purposes is available here
Updating or Replacing an I-693
If you submitted Form I-693 but USCIS has not yet adjudicated your I-485 and the medical exam has expired, you may be asked to provide a new one. You cannot amend an I-693 once it has been sealed and submitted. In such cases, you’ll need to undergo another full exam and obtain a new signed and sealed form. Keep in mind that the 60-day signature rule still applies if you are refiling or responding to an RFE.
Frequently Asked Questions
Can I submit a photocopy of Form I-693?
No. USCIS only accepts the original, signed Form I-693 in a sealed envelope from the civil surgeon.
Can I use my regular doctor for the exam?
No. Only USCIS-authorized civil surgeons can conduct the immigration medical examination and sign Form I-693.
Is insurance accepted for the exam?
Some civil surgeons may accept health insurance, while others may not. Always check in advance.
Do children need the medical exam?
Yes. All applicants, including minors, must complete the required components, though some vaccinations may be waived based on age.
Will I get my green card if I pass the medical exam?
Passing the medical exam is just one requirement. You must still meet all other eligibility criteria for adjustment of status.
Conclusion
Form I-693 is a vital part of the adjustment of status process and serves as a health screening to protect public safety while ensuring that prospective permanent residents meet immigration medical standards. Understanding the requirements, choosing a qualified civil surgeon, and submitting the form correctly can help avoid delays in green card processing. Always follow the most recent USCIS guidelines, keep copies of your exam records, and consult with an immigration attorney if your case involves complex medical or legal issues. For updates and official information, visit https://www.uscis.gov/i-693.
