Green Card Medical Exam: The Complete I-693 Guide for 2026

The immigration medical exam is one of the mandatory and most underestimated steps in the Green Card process. It does not assess whether you are healthy in the everyday clinical sense, but rather whether you meet the health admissibility criteria set forth in INA §212(a)(1), which list communicable diseases of public health significance, missing required vaccinations, physical or mental disorders with associated harmful behavior, and substance abuse. Understanding what is evaluated, by whom, on which form, and with what validity period prevents delays, requests for additional documentation, and even denials of adjustment of status.

What It Is and Its Legal Basis

The exam is governed by the Technical Instructions for Civil Surgeons and Panel Physicians, published by the Centers for Disease Control and Prevention (CDC) and adopted by USCIS and the Department of State. Those applying for permanent residence within the United States through adjustment of status (Form I-485) need the exam performed by a USCIS-designated civil surgeon. Those processing their case through a consulate abroad go through a panel physician authorized by the local American embassy or consulate. The location of authorized physicians can be confirmed using the official USCIS civil surgeon locator tool.

Within the US, results are recorded on Form I-693, Report of Immigration Medical Examination and Vaccination Record. The form must be submitted sealed to USCIS, without any intermediate opening by the applicant. The I-693 is valid for two years from the civil surgeon’s signature date, as outlined in the USCIS Policy Manual, Volume 8, Part B. In consular cases, the panel physician typically delivers a sealed envelope for the interview or transmits results electronically directly to the consulate.

Required Tests

Tests follow a standardized protocol, with adjustments based on the applicant’s age and medical history. The main tests are:

• Tuberculosis: IGRA (Interferon Gamma Release Assay) test for all applicants aged 2 and older. The skin test (TST) has not been accepted as a screening method since October 2018 within the US. A positive result requires a chest X-ray and, if abnormal, further evaluation for active tuberculosis.
• Syphilis: serological test required for applicants 18 years and older (age range updated by the CDC in 2024).
• Gonorrhea: test required for applicants between 18 and 24 years of age, per updated CDC technical instructions.
• Leprosy: clinical evaluation for all applicants, with additional investigation if suggestive signs are present.
• Mental health and substance use assessment: clinical interview to identify disorders with a history of harmful behavior and dependencies relevant to inadmissibility.

Additional laboratory tests, such as viral serologies and biochemical profiles, may be ordered at the physician’s discretion when symptoms, physical exam findings, or a relevant medical history are present.

Complete Required Vaccine Panel

The applicant must demonstrate immunization against a set of diseases listed by the CDC. If the complete vaccination record is unavailable, the civil surgeon can administer missing doses at the clinic or direct the applicant to where they can be obtained. Currently required vaccines include:

• Hepatitis A and Hepatitis B
• Influenza (seasonal, during the circulation season)
• Haemophilus influenzae type b (Hib) per age group
• Meningococcal per age group and context
• Measles, Mumps, and Rubella (MMR)
• Polio
• Rotavirus
• Tetanus, Diphtheria, and Pertussis (DTaP/Tdap)
• Varicella
• Pneumococcal

The COVID-19 vaccine requirement was removed on January 22, 2025. USCIS removed it from the panel and no longer requires proof of that immunization for I-693 purposes.

Typical Costs and How to Reduce Them

Within the United States, the civil surgeon exam typically ranges from $200 to $500, depending on the region and clinic. Missing vaccines and additional tests are billed separately and can raise the total cost. In consular cases, fees follow the local panel physician’s price schedule, published by the embassy.

Strategies to Reduce Costs

• Get quotes from at least three civil surgeons in your area; prices vary significantly for the same protocol.
• Update vaccinations at a public health clinic or authorized pharmacy before the appointment. Bring official records showing lot number, date, and facility stamp.
• Request transfer of recently completed lab results when the civil surgeon accepts external reports.
• Check whether your health insurance covers any vaccines or associated routine visits.

Documents to Bring to the Appointment

Gathering the correct documentation before the exam prevents having to redo steps and losing the sealed envelope. Bring:

• Valid passport or official photo ID.
• Complete vaccination record, translated if the physician requires it.
• Reports of hospitalizations, surgeries, and relevant chronic conditions.
• List of medications taken on a continuous basis with dosages.
• Copy of the consular interview appointment letter or I-485 notice, as applicable.
• Detailed medical reports if you have had tuberculosis, syphilis, psychiatric disorders, or a history of controlled substance use.

What to Expect During the Appointment

The appointment lasts, on average, one to two hours and follows a standardized procedure:

1. Medical history: review of medical, surgical, psychiatric, and substance use history.
2. Physical exam: evaluation of skin, lymph nodes, cardiac and pulmonary auscultation, basic neurological exam, and visual and hearing acuity.
3. Lab collection: blood and urine samples for required and additional tests.
4. Vaccination update: administration of pending doses, when requested by the applicant.
5. Sealing the envelope: at the end, the physician signs the I-693 and delivers the sealed envelope, which the applicant must not open.

Timelines, Validity, and Submission to USCIS

Within the US, the civil surgeon typically delivers the envelope within three to seven business days after the tests are completed. The I-693 is valid for two years from the physician’s signature date. It is generally advisable to align scheduling with the expected interview or I-485 adjudication date so the document is still valid when the officer reviews the petition. In consular cases, the exam must typically be completed before the interview and is valid for six months, unless chronic conditions shorten that period.

Common Mistakes That Delay the Case

The most common reasons for a Request for Evidence (RFE) related to the I-693 include: envelope opened by the applicant, discrepancies between the vaccination record and the required panel, missing civil surgeon signature or stamp, exam performed by a non-credentialed physician, and a form older than two years. Reviewing each field, keeping the envelope sealed, and verifying the physician’s credentials on the USCIS portal before scheduling the appointment are simple steps that prevent months of rework.

Treating the medical exam as a well-defined technical step — rather than a bureaucratic obstacle — simplifies organizing documentation, scheduling, and budgeting. With proper scheduling, up-to-date vaccinations, and careful selection of a civil surgeon, this phase tends to be one of the most predictable in the entire Green Card process.

Victoria Harper

Editor-in-Chief

Meet the author

Leading journalism and editorial content at Visto n’ Visa, Victoria helps make immigration topics clear, trustworthy, and easy to understand. Her focus is on delivering useful, human, and relevant content for people exploring new paths abroad.