Medical Exam Form I-693 for Green Card — What It Is

What Form I-693 Actually Does

USCIS doesn't evaluate your general health when you apply for a green card. Officers verify that you meet specific public health criteria defined in the Immigration and Nationality Act — freedom from communicable diseases of public health significance, current vaccination records, and no drug abuse or mental health conditions that pose a safety risk. Form I-693, the Report of Medical Examination and Vaccination Record, is the only document that certifies those findings.

The form must be completed by a USCIS-designated civil surgeon, sealed in an envelope signed across the flap by the physician, and submitted either with your Form I-485 (Application to Register Permanent Residence or Adjust Status) or in response to a Request for Evidence if USCIS issues one. The civil surgeon evaluates you against the regulatory checklist in 8 CFR § 212.1, not against general fitness standards. Individual health facts determine admissibility — the examination documents those facts for the adjudicating officer.

Here's the honest answer: the I-693 is not a pass/fail physical. It's a compliance document. The civil surgeon records what the examination finds — vaccinations received, TB test results, chest X-ray if indicated, and any Class A or Class B conditions identified. USCIS uses that record to determine whether you are admissible under the health-related grounds in INA § 212(a)(1). Most applicants are admissible; the examination proves it.

Who Must Complete Form I-693

Every applicant filing Form I-485 to adjust status to lawful permanent resident inside the United States must submit a completed I-693 unless USCIS grants a specific waiver. This includes family-based adjustments (immediate relatives and family preference categories), employment-based green cards (EB-1, EB-2, EB-3, EB-4, EB-5), refugees and asylees adjusting after one year, diversity visa selectees adjusting status, and special immigrant categories.

Applicants who process their immigrant visas abroad through consular processing complete a different medical examination using Form DS-2054 and DS-3025, administered by panel physicians designated by the U.S. Department of State. Those forms serve the same statutory purpose but follow Department of State protocols. Only adjustment-of-status applicants inside the United States use Form I-693.

Children under 18 and adults over 18 follow the same examination requirements, though the vaccination schedule differs by age. USCIS does not exempt elderly applicants, pregnant applicants, or applicants with disabilities from the medical examination requirement — though pregnancy may defer certain vaccines, and documented medical contraindications can justify blanket waivers for specific vaccinations.

What the Civil Surgeon Actually Examines

The civil surgeon conducts a physical examination, reviews your vaccination history, performs or orders tuberculosis screening, and evaluates you for communicable diseases of public health significance and mental health or substance abuse conditions that could pose a danger. The examination is structured around four regulatory categories defined in 8 CFR § 212.1:

Class A conditions — inadmissibility findings that generally prevent adjustment of status without a waiver. These include communicable diseases of public health significance (active tuberculosis, infectious syphilis, gonorrhea, leprosy); failure to present documentation of required vaccinations; mental disorders with associated harmful behavior; and drug abuse or addiction.

Class B conditions — physical or mental abnormalities, diseases, or disabilities that are serious in degree or nature and may affect the applicant's ability to care for themselves, attend school, or work, but do not render the applicant inadmissible. These are noted on the form but do not block adjustment.

The tuberculosis screening protocol depends on age and risk factors. Applicants age 2 and older receive a tuberculin skin test (TST) or interferon-gamma release assay (IGRA) blood test. A positive screening test triggers a chest X-ray to rule out active tuberculosis. If the X-ray shows findings consistent with tuberculosis, the civil surgeon refers the applicant to the local health department for sputum culture and treatment evaluation. Active tuberculosis is a Class A inadmissibility; a history of treated tuberculosis without current active disease is not.

The vaccination review compares your records to the vaccine requirements in 8 CFR § 212.1(a)(3)(ii). As of 2026, USCIS requires documentation of vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) for the applicant's age group, including: mumps, measles, rubella; polio; tetanus and diphtheria toxoids; pertussis; Haemophilus influenzae type B (Hib); hepatitis A; hepatitis B; varicella; influenza; pneumococcal disease; rotavirus; meningococcal disease; and COVID-19. The civil surgeon administers any missing age-appropriate vaccines during the examination or issues a blanket waiver if a medical contraindication exists and is documented.

The Sealed Envelope Rule and Why It Matters

After completing the examination and Form I-693, the civil surgeon places the signed form in an envelope, seals it, and signs across the sealed flap. The applicant submits the sealed envelope to USCIS unopened. If the envelope arrives opened, torn, or without the civil surgeon's signature across the seal, USCIS will reject it and issue an RFE for a new examination.

This protocol ensures the integrity of the medical findings. USCIS adjudicators rely on the civil surgeon's certification that the examination was conducted according to the Technical Instructions for Civil Surgeons and that the findings are accurate as of the examination date. An opened envelope raises the possibility that the form was altered after the physician signed it.

The envelope must remain sealed from the civil surgeon's office to the USCIS mailbox or your attorney's filing package. If you file your I-485 with the medical exam included, the sealed I-693 envelope goes inside the larger mailing envelope with the rest of your application. If USCIS issues an RFE requesting the medical exam, you mail the sealed envelope in response. You may make a photocopy of the form for your records before the civil surgeon seals it, but the submitted envelope must be unopened.

When to Complete the Examination (the 60-Day Window)

Form I-693 is valid only if the civil surgeon signs it no more than 60 days before you file Form I-485. If the examination is dated more than 60 days before your filing date, USCIS will reject the medical exam and request a new one. This 60-day rule applies to the civil surgeon's signature date on the form, not the date you received your vaccinations or had your TB test — those components can occur earlier as long as the civil surgeon reviews and signs the completed form within the 60-day window.

Once submitted with your I-485, the form remains valid for two years from the civil surgeon's signature date. If USCIS does not adjudicate your case within that two-year period, the agency will issue an RFE for a new I-693. Most adjustment cases are decided within two years, but cases delayed by backlogs, security checks, or administrative processing can exceed that window.

You have two filing options: submit the I-693 with your initial I-485 application, or wait for USCIS to request it via RFE. Filing it with the I-485 avoids delay — the case is ready for adjudication when the officer reviews it. Waiting for the RFE delays your case by the RFE response period (usually 87 days) but gives you more time to complete the exam if you are close to the 60-day cutoff. Most applicants file the medical exam with the I-485.

How to Find a USCIS-Designated Civil Surgeon

Only physicians on the USCIS civil surgeon list may complete Form I-693. The list is maintained by USCIS and updated regularly. To find a civil surgeon in your area, visit the USCIS Civil Surgeon Locator tool at uscis.gov/tools/find-a-civil-surgeon. Enter your ZIP code; the tool returns civil surgeons within a specified radius, including their contact information and languages spoken.

Not every family doctor, urgent care clinic, or general practitioner is a designated civil surgeon. The physician must have completed USCIS training on the Technical Instructions, registered with the agency, and maintained active designation. If you complete the examination with a non-designated physician, USCIS will reject the form and you will pay for a second examination with a qualified civil surgeon.

Civil surgeons set their own fees for the I-693 examination. USCIS does not regulate or publish standard fees, and costs vary by location, the number of vaccines you need, and whether the practice includes the TB test and chest X-ray in the base fee or bills them separately. Contact civil surgeons in your area to compare pricing. The examination fee is separate from the USCIS filing fees for Form I-485.

What If the Civil Surgeon Identifies a Class A Condition?

A Class A finding does not automatically deny your green card, but it does require additional steps. If the civil surgeon diagnoses active tuberculosis, you must complete treatment under the supervision of the local health department before USCIS will approve your I-485. The health department issues a completion certificate, and you submit that certificate with a new I-693 showing you are no longer Class A inadmissible.

If the finding is failure to present vaccination documentation and you have a medical contraindication (allergy, prior adverse reaction, pregnancy for certain live vaccines), the civil surgeon issues a blanket waiver and notes it on Form I-693. USCIS accepts the waiver if it is properly documented. If you object to vaccinations on religious or moral grounds, you may submit Form I-601 (Application for Waiver of Grounds of Inadmissibility), though USCIS rarely grants vaccination waivers on non-medical grounds.

Infectious syphilis or gonorrhea requires treatment before the form is finalized. The civil surgeon refers you for treatment, verifies completion, and then signs the I-693 certifying that the infection has been treated. A past history of treated syphilis or gonorrhea does not create a Class A finding.

What If USCIS Issues an RFE for a New I-693?

If your original I-693 is more than two years old by the time USCIS adjudicates your case, the agency will issue an RFE requesting a new medical examination. You must schedule a new appointment with a civil surgeon, complete the full examination and vaccination review again, and submit the new sealed form within the RFE response deadline (typically 87 days).

The new examination follows the same protocols as the original. The civil surgeon will review your updated vaccination records — if you received missing vaccines during the first exam, bring that documentation so you are not re-vaccinated unnecessarily. The TB screening is repeated unless you have a documented positive TST or IGRA from the past, in which case the civil surgeon may rely on that result and order a chest X-ray if indicated.

If the RFE deadline is tight and you cannot schedule with your original civil surgeon in time, use the USCIS locator tool to find another designated physician. The new civil surgeon does not need access to your prior I-693 — the examination is conducted fresh.

What If You File I-485 Without the Medical Exam?

USCIS accepts I-485 applications without Form I-693 and issues an RFE requesting the medical exam later. This delays your case by the RFE response period but does not invalidate your filing. If you file without the I-693 because you were close to the 60-day signature cutoff and wanted to lock in your priority date or preserve eligibility under a soon-to-expire provision, the delay may be worth the trade-off.

Some applicants file without the exam if they are waiting for a vaccine series to complete (hepatitis B requires three doses over six months; some civil surgeons will not sign the form until the series is finished, while others will administer the first dose and issue a waiver for the remainder if time does not allow completion). If you file without the I-693 for this reason, complete the series during the RFE period and submit the final form with full documentation.

How the Law Offices of Peter D. Chu Handles I-693 Coordination

The Law Offices of Peter D. Chu in San Diego assists clients in coordinating the I-693 examination as part of the adjustment of status process. The firm provides a list of civil surgeons in the San Diego area who are familiar with USCIS requirements, explains the 60-day filing window, and reviews the completed sealed form to confirm the civil surgeon's signature and seal are intact before the I-485 package is mailed.

If USCIS issues an RFE for a new medical exam, the firm notifies the client immediately, calculates the response deadline, and coordinates the new examination to ensure the sealed form is submitted on time. The firm's multilingual staff — fluent in Mandarin, Cantonese, Vietnamese, and French — can explain the vaccination requirements and TB screening process to clients who prefer consultation in those languages.

The initial consultation fee is $250. During that consultation, the firm reviews your adjustment timeline, advises on the optimal timing for the I-693 examination, and answers questions about specific vaccination or health concerns that may affect the medical exam outcome. To schedule, call 858-268-8823 or visit peterchu.com.

Disclaimer: This article provides general information about Form I-693 and the green card medical examination process. It is not legal advice and does not create an attorney-client relationship between the reader and the Law Offices of Peter D. Chu. Immigration outcomes depend on individual facts, current regulations, and agency policy at the time of adjudication. Consult a licensed immigration attorney for advice specific to your case.

Schedule a consultation with the Law Offices of Peter D. Chu — 4615 Convoy St, San Diego, CA 92111 · 858-268-8823 · Mon–Fri, 8:30 AM–5:30 PM. Consultation fee: $250.