Form I-693 Immigration Medical Exam Guide 2026

Form I-693, officially titled Report of Immigration Medical Examination and Vaccination Record, is used by most applicants seeking adjustment of status to show that they are not inadmissible to the United States on health-related grounds. The form documents an immigration medical examination completed by a physician designated by U.S. Citizenship and Immigration Services as a civil surgeon.

The immigration medical exam is not a routine annual physical and it does not determine whether an applicant qualifies for a Green Card under every immigration rule. Its purpose is narrower: to identify medical conditions addressed by the Immigration and Nationality Act, verify compliance with applicable vaccination requirements, and provide USCIS with properly certified medical evidence.

Most adjustment applicants must submit a properly completed Form I-693 with Form I-485.

Using the wrong physician, presenting an incomplete form, opening or altering the sealed envelope in a paper filing, or omitting required medical evidence can result in rejection, a Request for Evidence, delays, or a denial if the applicant ultimately fails to establish admissibility.

Last reviewed: August 6, 2026. USCIS forms, filing procedures, and CDC medical instructions can change. Applicants should verify the current Form I-693 edition and USCIS instructions before attending the examination or submitting a filing.

Form I-693 at a Glance

• Form I-693 records the immigration medical examination and vaccination assessment.
• The examination must normally be completed by a USCIS-designated civil surgeon in the United States.
• A regular family doctor cannot sign Form I-693 unless that physician is also an authorized civil surgeon or qualifies under a limited blanket designation.
• Most applicants filing Form I-485 must include Form I-693 with the adjustment package.
• USCIS does not charge a separate filing fee for Form I-693, but the civil surgeon charges for the examination, laboratory work, and any vaccines provided.
• COVID-19 vaccination documentation is no longer required for adjustment-of-status applicants.
• Required vaccines depend on the applicant’s age, vaccination history, medical circumstances, season, and CDC instructions.
• For a paper filing, the civil surgeon must place the original completed form in a sealed envelope that the applicant should not open or alter.
• A Form I-693 signed on or after November 1, 2023, is generally valid while the immigration benefit application with which it was submitted remains pending.
• USCIS may request updated medical evidence when necessary to determine current admissibility.

What Is Form I-693?

Form I-693 is the official USCIS medical report used in many adjustment-of-status cases.

According to the USCIS Form I-693 guidance, the form helps establish that an applicant is not inadmissible under the health-related grounds described in section 212(a)(1) of the Immigration and Nationality Act.

The current form is divided into sections completed by the applicant, civil surgeon, and any physicians or health departments involved in required referrals or vaccination assessments. The civil surgeon records the applicant’s medical history, examination results, laboratory findings, vaccination record, and medical classification.

Form I-693 does not replace Form I-485. It is supporting evidence submitted as part of an adjustment-of-status case or another USCIS process that requires proof of medical admissibility. Applicants preparing a Green Card application inside the country should review the complete I-485 adjustment of status guide in addition to the medical requirements.

Who Needs an Immigration Medical Exam?

Most people applying for lawful permanent residence through adjustment of status must comply with the immigration medical examination and vaccination requirements. This includes many family-based, marriage-based, employment-based, humanitarian, special immigrant, and Diversity Visa adjustment applicants.

The exact requirement depends on the immigration category and whether the applicant previously completed an examination with a Department of State panel physician outside the United States. USCIS distinguishes between civil surgeons, who generally examine applicants whose immigration benefits are processed inside the United States, and panel physicians, who generally examine visa applicants abroad.

A medical examination completed by an ordinary doctor is not sufficient merely because that doctor is licensed to practice medicine. The physician must appear in the official USCIS civil surgeon system or qualify under a specific blanket designation.

Civil Surgeon vs. Panel Physician

Medical provider	Where the provider works	Typical applicant	Primary medical document
USCIS-designated civil surgeon	Inside the United States	Adjustment-of-status applicant	Form I-693
Department of State panel physician	Outside the United States	Immigrant or certain nonimmigrant visa applicant	Department of State medical forms

The two roles are not interchangeable. A doctor who performs immigrant visa examinations abroad does not automatically qualify to complete a new Form I-693 in the United States. Likewise, a U.S. civil surgeon does not normally perform the overseas medical examination required for consular immigrant visa processing.

How to Find a USCIS Civil Surgeon

Use the official USCIS Find a Civil Surgeon tool or the doctor search available through myUSCIS. Search by ZIP code and confirm that the physician remains listed before scheduling the appointment.

Applicants may contact several offices because prices, appointment availability, laboratory arrangements, vaccine charges, and document policies vary. Before choosing a clinic, ask:

• Is the quoted price for the entire immigration medical examination?
• Are tuberculosis, syphilis, gonorrhea, or other laboratory tests included?
• Are vaccines or laboratory immunity tests billed separately?
• Does the office accept outside vaccination records and laboratory results?
• How many visits are normally required?
• How long will it take to receive the completed sealed envelope?
• Will the office provide a copy of the completed Form I-693 for personal records?
• What identification and medical records should the applicant bring?

USCIS does not set or regulate the amount a civil surgeon charges. A lower advertised price may not include laboratory work, vaccines, follow-up visits, or treatment required before the physician can complete the form. Request an itemized estimate before the examination begins.

What to Bring to the Immigration Medical Exam

The clinic may establish its own intake requirements, but applicants commonly need to bring:

• A valid government-issued photo identification, such as a passport or driver’s license.
• Identification appropriate for a child who does not have a standard photo ID.
• Available written vaccination records.
• Records showing prior treatment for tuberculosis or another relevant communicable disease.
• Records concerning significant physical or mental health conditions when requested.
• A list of current medications.
• Records concerning prior substance-use treatment or related diagnoses when applicable.
• Prior immigration medical examination documents, if available.
• The current edition of Form I-693 if the clinic requires the applicant to bring it.
• Payment and health insurance information if the clinic accepts insurance for any covered services.

Applicants should bring original vaccination documentation when possible. Self-reported vaccination history generally does not carry the same value as reliable written records, although the civil surgeon may consider laboratory evidence of immunity for certain diseases when permitted by CDC instructions.

Do not sign the applicant certification before the clinic instructs you to do so.

The applicant normally signs in the presence of the civil surgeon or authorized clinic personnel as required by the form instructions.

What Happens During the Immigration Medical Exam?

The civil surgeon must follow the CDC Technical Instructions for Civil Surgeons. The examination is designed to identify health-related grounds of inadmissibility, not to provide a complete assessment of every possible medical condition.

Medical History

The physician reviews the applicant’s medical history, including significant illnesses, hospitalizations, communicable diseases, mental health conditions, harmful behavior, substance use, and vaccination history. Applicants should answer truthfully and provide requested supporting records.

Physical Examination

The examination generally includes an evaluation of the eyes, ears, nose, throat, heart, lungs, abdomen, lymph nodes, skin, and extremities. The physician may also evaluate mental status and other findings required under the CDC instructions.

Tuberculosis Screening

Tuberculosis screening follows age-specific CDC rules. Depending on the applicant’s age, history, symptoms, test results, and possible exposure, the process may include a blood test, chest X-ray, sputum testing, referral, or treatment documentation.

A previous BCG vaccination does not automatically remove the tuberculosis screening requirement. Applicants with a history of tuberculosis should bring treatment and diagnostic records to the appointment.

Syphilis and Gonorrhea Testing

Testing requirements depend on the applicant’s age and the current CDC Technical Instructions. The civil surgeon may also order testing outside the standard age range when medical history, symptoms, or examination findings indicate that testing is necessary.

Mental Health and Substance-Related Review

A mental health diagnosis alone does not automatically make an applicant inadmissible. The medical analysis focuses on whether a physical or mental disorder is associated with harmful behavior and whether that behavior is current or likely to recur. Drug abuse or addiction can also create a health-related inadmissibility issue under immigration law.

Vaccination Assessment

The civil surgeon reviews written vaccination records, determines which requirements apply to the applicant, and records the results on Form I-693. The applicant may need one or more vaccines, laboratory evidence of immunity, or documentation that a vaccine is not medically appropriate.

Vaccines Required for Form I-693

There is no single vaccine list that every applicant must complete in exactly the same way. The CDC considers the applicant’s age, prior doses, reliable vaccination records, documented immunity, medical contraindications, pregnancy, season, and required intervals between doses.

The CDC vaccination instructions currently cover age-appropriate vaccination against the following diseases:

• Diphtheria
• Tetanus
• Pertussis
• Polio
• Measles
• Mumps
• Rubella
• Rotavirus
• Haemophilus influenzae type b
• Hepatitis A
• Hepatitis B
• Meningococcal disease
• Varicella
• Pneumococcal disease
• Influenza

An applicant is not necessarily required to complete every dose in a multi-dose series before the civil surgeon can certify the vaccination record. When the minimum interval for another dose has not passed, the physician can document the appropriate blanket-waiver reason. The civil surgeon determines what must be administered or documented under the current instructions.

Is the COVID-19 Vaccine Required for Form I-693?

No. Effective January 22, 2025, USCIS waived the requirement for adjustment applicants to document COVID-19 vaccination on Form I-693. USCIS stated that it would not issue an RFE or Notice of Intent to Deny, and would not deny an adjustment application, solely because Form I-693 did not establish COVID-19 vaccination compliance.

The waiver applies specifically to the immigration documentation requirement. It does not prevent a healthcare provider from recommending vaccination for ordinary medical reasons, and it does not remove the other age-appropriate immigration vaccination requirements.

Vaccination Waivers and Medical Exceptions

Several situations can allow a required vaccine to be marked as not medically appropriate without the applicant filing a separate waiver application. The civil surgeon may document a blanket-waiver reason such as:

• The vaccine is not appropriate for the applicant’s age.
• A medical contraindication or precaution applies.
• The minimum interval between required doses has not passed.
• The influenza vaccine is not available because it is not flu season.

A person who objects to all required vaccinations because of sincere religious beliefs or moral convictions may need to request an individual waiver. That process is different from a medically documented blanket waiver and may require a separate immigration waiver application, filing fee, and supporting evidence.

Can a Pregnant Applicant Complete Form I-693?

Pregnancy does not automatically prevent completion of the immigration medical examination. The civil surgeon must follow current CDC precautions and contraindications for vaccines and diagnostic procedures.

Some vaccines may be contraindicated or deferred during pregnancy, while others may remain appropriate. A pregnant applicant should tell the clinic before testing or vaccination and should bring relevant prenatal or medical records when requested.

When a chest X-ray is medically required under the tuberculosis instructions, the civil surgeon and radiology provider should explain the applicable protective procedures and current medical guidance. Applicants should not assume that pregnancy automatically eliminates every diagnostic requirement.

Class A and Class B Medical Conditions

The civil surgeon classifies relevant findings under the CDC Technical Instructions. The classification affects how USCIS evaluates health-related admissibility.

Class A Conditions

A Class A condition can create a health-related ground of inadmissibility. Depending on the condition and immigration category, the applicant may need treatment, additional testing, proof of remission, compliance with a treatment plan, or an available waiver before USCIS can approve the case.

Examples of issues that may produce a Class A classification include certain communicable diseases of public health significance, failure to comply with applicable vaccination requirements, certain disorders associated with harmful behavior, and drug abuse or addiction as defined by the immigration medical instructions.

Class B Conditions

A Class B condition is a significant health condition that does not, by itself, make the applicant inadmissible under the medical grounds. It may require follow-up care or provide USCIS with relevant information, but a Class B classification is not the same as a medical denial.

USCIS, not the civil surgeon, makes the legal decision on admissibility and adjustment eligibility. The physician records the medical findings and classification but does not approve or deny the Green Card application.

Form I-693 Edition Date

At the time of this review, the current Form I-693 displays an edition date of 01/20/25. Applicants and clinics should always confirm the accepted edition on the official USCIS page before the civil surgeon signs the form.

The edition date appears at the bottom of the form pages. Every page in the submitted form should come from the same accepted edition. USCIS may reject or refuse to accept a form containing missing pages, pages from different editions, or an edition that is no longer accepted.

Because the civil surgeon controls the medical certification, applicants should not replace pages, alter answers, add information after sealing, or combine parts of different copies.

When to Submit Form I-693 with Form I-485

Since December 2, 2024, USCIS has required certain applicants who need Form I-693 to submit it with Form I-485. Current instructions state that most adjustment applicants must include the medical report with the adjustment application.

When Form I-693 or a required portion of the form is mandatory initial evidence, omitting it can cause USCIS to reject Form I-485 at intake. A rejection means USCIS does not accept the adjustment application as properly filed. This differs from an RFE issued after USCIS has accepted a case.

Applicants whose Form I-485 is already pending should follow the specific instructions issued by USCIS. Do not mail an unsolicited medical envelope to a random USCIS address. USCIS may request the form through an RFE, direct the applicant to bring it to an interview, or provide another submission method.

For a paper filing, place the unopened civil surgeon envelope in the adjustment package as directed by the Form I-485 and Form I-693 instructions. Applicants using an electronic filing option should follow the instructions shown in the USCIS online account because document-upload and original-retention procedures may differ from a paper filing.

Should the Applicant Open the Form I-693 Envelope?

For a paper submission, no. The civil surgeon must place the completed original form and supporting medical documentation in a sealed envelope. USCIS instructions warn that the agency will not accept the form if the envelope has been opened or altered.

The civil surgeon should also provide the applicant with a copy of the completed vaccination record and may provide a complete personal copy. Review that copy for obvious biographical errors before filing, but do not open the USCIS envelope merely to inspect the original.

If the envelope is damaged, unsealed, contains an incorrect name, or appears incomplete, contact the civil surgeon’s office before submitting it. The clinic may need to correct and reseal the package.

How Long Is Form I-693 Valid?

Under the USCIS policy effective June 11, 2025, a properly completed Form I-693 signed by a civil surgeon on or after November 1, 2023, is generally valid while the immigration benefit application with which it was submitted remains pending.

This means the form is not a reusable medical certificate for unrelated or later applications. If the associated Form I-485 is withdrawn, denied, or otherwise no longer pending, the applicant generally cannot reuse the same Form I-693 with a newly filed adjustment application.

The rule replaced the earlier policy that treated qualifying forms as having indefinite evidentiary value. USCIS may also request new medical evidence when an officer has reason to believe the applicant’s health circumstances have changed or the existing documentation is incomplete, inaccurate, or insufficient.

Applicants with a form signed before November 1, 2023, should not assume that the newer pending-application rule applies in the same way. Earlier forms remain subject to the evidentiary rules that governed those signatures.

How Much Does the Immigration Medical Exam Cost?

There is no national USCIS price for the immigration medical examination. Each civil surgeon establishes the clinic’s own fees, and the total can vary depending on location, laboratory testing, missing vaccines, required imaging, medical records, referrals, and follow-up visits.

Form I-693 itself does not carry a separate USCIS filing fee. The applicant pays the medical provider for professional services and any tests or vaccines not otherwise covered.

When comparing clinics, request a written or itemized estimate that explains whether the quoted amount includes:

• The civil surgeon examination.
• Required blood or urine tests.
• Tuberculosis screening.
• A chest X-ray if required.
• Vaccines administered by the clinic.
• Laboratory immunity testing.
• Follow-up visits.
• Completion and sealing of Form I-693.
• Corrections caused by a clinic error.
• A personal copy of the completed form.

Health insurance may cover some ordinary vaccines or diagnostic services, but many plans do not cover the immigration examination itself. Applicants can ask whether missing vaccines may be obtained through a primary care provider, pharmacy, or public health clinic before the civil surgeon completes the form.

Special Rules for K Visa Entrants

K-1, K-2, K-3, and K-4 entrants normally complete a medical examination with a panel physician before receiving the visa. They may not need to repeat the full examination when applying for adjustment if Form I-485 is filed within one year of the original medical examination and the prior examination did not reveal a disqualifying Class A condition, or the applicant complied with an applicable waiver.

Vaccination compliance is still required for adjustment. When the overseas physician did not complete the vaccination requirements, a U.S. civil surgeon may need to complete the relevant vaccination portion of Form I-693.

Special Rules for Refugees and Asylees

Refugees who completed an overseas examination before admission generally do not repeat the entire medical examination when adjusting status unless the original examination identified a Class A condition or another rule requires a new examination. Refugees must still establish vaccination compliance at adjustment through the relevant portions of Form I-693.

USCIS grants state and local health departments a limited blanket civil surgeon designation for completing vaccination assessments for refugees. This limited designation does not authorize those health departments to perform every component of a full immigration examination for all adjustment applicants.

Asylees generally undergo an immigration medical examination, including the vaccination assessment, when applying for adjustment. A limited exception may apply to certain derivative asylees who completed a qualifying overseas examination, apply within the required period, have no Class A finding, and have no indication of a newly acquired Class A condition. Even in that situation, vaccination compliance must still be documented.

What Happens if Form I-693 Is Incomplete?

The result depends on when the problem is discovered and whether Form I-693 was required as initial evidence. USCIS may:

• Reject Form I-485 when a required Form I-693 is missing at filing.
• Issue an RFE for missing, incomplete, or incorrectly completed medical documentation.
• Ask the applicant to obtain a corrected form from the civil surgeon.
• Request a new examination when the evidence no longer establishes current admissibility.
• Issue a Notice of Intent to Deny when the record indicates a possible ground of inadmissibility.
• Deny the application if the applicant fails to establish admissibility after receiving an opportunity to respond.

Do not attempt to correct the civil surgeon’s entries yourself. Any correction to the medical findings or physician certification must be handled by the authorized medical provider and properly resealed when a sealed original is required.

Common Form I-693 Mistakes

• Using a doctor who is not designated as a civil surgeon.
• Using an outdated edition of Form I-693.
• Signing the applicant certification at the wrong time.
• Failing to bring reliable vaccination records.
• Assuming every vaccine is required for every age.
• Assuming COVID-19 vaccination remains mandatory.
• Opening or altering the sealed envelope intended for a paper filing.
• Submitting photocopies when USCIS requires the sealed original.
• Mailing Form I-693 separately without USCIS instructions.
• Failing to include the form with Form I-485 when it is required as initial evidence.
• Believing an ordinary medical examination can replace the immigration examination.
• Assuming Form I-693 can be reused after the related application is denied or withdrawn.
• Failing to review personal copies for incorrect names, dates, or identification numbers.
• Waiting until the last moment to schedule an appointment or complete required follow-up testing.

Form I-693 Filing Checklist

• Confirm that Form I-693 is required for the immigration category.
• Verify the current edition on the official USCIS website.
• Choose a physician through the USCIS civil surgeon search tool.
• Request a complete price estimate before the appointment.
• Gather photo identification and vaccination records.
• Bring relevant tuberculosis, treatment, mental health, or other requested records.
• Complete only the applicant portions directed by the clinic.
• Sign the form as instructed by the civil surgeon.
• Complete required testing, vaccinations, referrals, or follow-up visits.
• Obtain the sealed original and a personal copy.
• Do not open or alter the sealed envelope for a paper filing.
• Confirm that the applicant’s name and biographical information are correct.
• Submit the form with Form I-485 when required.
• Follow any RFE or interview instructions exactly.
• Keep personal medical and vaccination copies in a secure location.

A correctly prepared Form I-693 can prevent avoidable rejection and delays, but it does not guarantee approval of the Green Card application. USCIS must still evaluate the applicant’s adjustment eligibility, immigration history, visa availability, financial evidence, criminal history, security checks, and every other applicable ground of inadmissibility. Applicants with a Class A condition, prior substance-related findings, complex mental health history, or a possible waiver issue should obtain individualized advice from a qualified U.S. immigration attorney before responding to USCIS.