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Since December 2024, U.S. Citizenship and Immigration Services (USCIS) requires that every application for adjustment of status (Form I-485) be filed together with Form I-693, the Report of Medical Examination and Vaccination Record signed by a designated civil surgeon. The change ends the previous practice, in which the document could be submitted later during case adjudication, and aims to reduce the volume of Requests for Evidence (RFEs) that were delaying decisions by months.
The new rule particularly affects those adjusting status inside the United States — that is, green card applicants already on U.S. soil under another immigration status. For these cases, submission of the I-693 is no longer optional at the initial filing stage and becomes an indispensable part of the filing package. Incomplete petitions may be rejected, and the administrative clock only starts when all required forms are present.
What Changed in the Medical Requirement
Before the update, it was common for the I-485 to be accepted without the I-693, with USCIS requesting the exam later — usually close to the interview or following a request for additional evidence. This workflow generated delays of six to twelve months in thousands of cases per year. Under the current rule, the medical exam becomes a filing prerequisite, aligning the I-485 with the same standard already applied to immigrant visas processed at consulates, where the exam is part of the consular package.
The USCIS-designated civil surgeon is the only professional authorized to complete and sign the I-693. The official list is available at uscis.gov/find-doctor and covers the entire United States, with hundreds of credentialed physicians. In Brazil, only a limited number of doctors are credentialed for consular immigrant visa exams, but since the I-693 linked to adjustment of status is conducted on U.S. soil, the supply of qualified professionals is ample in major U.S. cities.
Components of the I-693 Exam
The exam combines a clinical evaluation, medical history review, laboratory tests, and vaccination history review. The applicant must present official identification and, whenever possible, prior vaccination records, recent medical exams, and current prescriptions.
Conditions Assessed for Inadmissibility
The civil surgeon checks for conditions classified as grounds for medical inadmissibility under section 212(a)(1)(A) of the Immigration and Nationality Act (INA). The main categories are communicable diseases of public health significance, lack of required vaccinations, physical or mental disorders with associated harmful behavior, and substance dependence or abuse.
Tuberculosis testing now uses the interferon-gamma release assay (IGRA) as the standard protocol for individuals over two years of age, replacing the traditional tuberculin skin test in many scenarios. Syphilis, gonorrhea, and leprosy are also assessed, and hepatitis has been included in updated protocols in recent years.
Required Vaccinations
The applicant must prove immunization against diseases whose list is defined by the CDC and the Advisory Committee on Immunization Practices (ACIP). The set includes measles, mumps, rubella, polio, tetanus, diphtheria, pertussis, hepatitis A, hepatitis B, varicella, seasonal influenza, pneumococcal disease, rotavirus where applicable by age, Haemophilus influenzae type b, meningococcal disease, and COVID-19. The list is updated periodically, and the civil surgeon consults the current version on the date of the exam.
Those without proof of vaccination can receive the vaccines during the exam itself or at a partner clinic. Waiver provisions exist for medical contraindications, incompatible age, or sincerely held religious beliefs, but each exception must be formally justified in the report.
Validity and Deadlines of the Report
The signed I-693 is valid for two years from the civil surgeon’s signature date. This period begins on the date of signature, not on the date the exam was actually performed. To prevent the document from expiring during adjudication, it is best to schedule the exam close to the intended I-485 filing date, and never too many months in advance.
If the exam expires before USCIS issues a final decision, the applicant may receive a Request for Evidence asking for an updated I-693. Repeating the exam involves a new appointment with a credentialed civil surgeon, additional laboratory costs, and extra time — factors that underscore the importance of correct timing on the initial submission.
Costs and Logistics
The cost of the medical exam is not set by USCIS. In mid-2025, civil surgeons in the United States charged between $200 and $600, depending on the city, the volume of required laboratory tests, and any vaccines that need to be administered at the time. Locations such as California, New York, and Massachusetts tend to have a higher average cost than states in the South and Midwest.
The applicant should bring a photo ID, prior vaccination records in physical or digital format, a list of current medications, and any relevant documentation regarding chronic conditions. The surgeon submits the sealed report, and in many cases the document is already compatible with electronic I-485 filing when the applicant chooses the online submission option.
Mistakes That Jeopardize the Application
The most common mistake is having the exam performed by a professional not credentialed by USCIS, which automatically invalidates the document. Another recurring error is submitting the I-693 in an open envelope, outside the civil surgeon’s original seal — a situation that also leads to rejection. Inconsistent signature dates, missing vaccines without formal justification, and an incomplete communicable disease section are among the most common grounds for RFE issuance.
Applicants living in small cities should allow extra time for travel, as credentialed civil surgeons may be concentrated in metropolitan areas. Scheduling the appointment at least six weeks before the intended I-485 filing date reduces the risk of delays.
Context for the Brazilian Community
Brazil holds a prominent position among countries with the highest number of green cards issued. In 2023, the Department of Homeland Security recorded 28,050 Brazilians receiving U.S. permanent residence — the highest volume ever recorded for the country, a 16% increase over 2022, with Brazil ranking tenth globally, behind Mexico, India, Cuba, the Dominican Republic, and China.
For this group, the concurrent medical exam rule primarily affects those adjusting status inside the United States — a situation typical of H-1B, L-1, F-1, O-1, and other nonimmigrant visa holders who reach their priority date and file the I-485. Those processing the green card through a consulate continue submitting the exam at the corresponding consulate, following the same model already in place. In either scenario, planning the exam with appropriate lead time and choosing a USCIS-credentialed civil surgeon are practical steps that prevent months of rework.
Victoria Harper
Editor-in-Chief
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.
