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The I-693 Form (Report of Medical Examination and Vaccination Record) is a mandatory document for most adjustment of status processes in the United States. Completed by a physician authorized by USCIS, it certifies that the applicant does not have health conditions that pose a risk to American public health. Understanding the requirements, the exams involved, and the updated validity rules is essential to avoid delays in obtaining the Green Card.
What is the I-693 Form
The I-693 is the official immigration medical examination report required by USCIS (U.S. Citizenship and Immigration Services) as part of the adjustment of status process for permanent residency. The document serves two main purposes: identifying communicable diseases of public health significance, such as tuberculosis and syphilis, and verifying that the applicant’s vaccination record complies with U.S. health authority requirements.
Since December 2024, USCIS requires the I-693 Form to be submitted together with the I-485 Form (Application to Register Permanent Residence or Adjust Status). Previously, it was possible to submit the I-693 at a later time, but this option is no longer available for most cases.
Role of the Civil Surgeon
The immigration medical exam cannot be performed by just any doctor. Within the United States, it must be conducted by a Civil Surgeon, a professional designated and authorized by USCIS specifically to perform immigration exams. The list of accredited Civil Surgeons can be found directly on the USCIS website, filtered by state and city. For applicants undergoing consular processing outside the U.S., the exam is conducted by a panel physician accredited by the local American consulate.
During the medical exam
The I-693 exam follows a standardized protocol established by the CDC (Centers for Disease Control and Prevention) through the Technical Instructions for Civil Surgeons. The procedure is straightforward and usually completed in one or two appointments.
Clinical evaluation and history
The doctor performs a basic physical exam and collects information about previous illnesses, surgeries, current medications, and general health history. This evaluation aims to identify conditions that may constitute inadmissibility on health grounds under INA § 212(a)(1).
Mandatory laboratory tests
Mandatory laboratory tests include a blood test for syphilis, a tuberculosis test (usually the IGRA, a blood test that has replaced the traditional PPD skin test in most cases), and a urine test for gonorrhea in certain age groups. If the tuberculosis test is positive, a chest X-ray will be requested to rule out active tuberculosis.
Mental health assessment
The Civil Surgeon conducts a basic mental health assessment to identify conditions that may pose a risk to public safety. This assessment is brief and part of the standard protocol; it is not a full psychiatric consultation.
Vaccination history
One of the most important components of the exam is the review of vaccination history. The doctor checks whether the applicant has received all vaccines required by U.S. law for their age group. Mandatory vaccines include, among others, measles, mumps, rubella, polio, tetanus, diphtheria, pertussis, hepatitis A and B, varicella, and influenza. It is worth noting that, since March 2025, COVID-19 vaccination has been removed from the list of mandatory vaccines for immigration purposes. If the applicant does not have all required vaccines, the Civil Surgeon can administer them during the appointment or prescribe them to be taken elsewhere.
How to prepare
Preparation for the exam is simple but requires organization. On the day of the appointment, the applicant should bring the following items: a copy of the I-693 Form with the applicant’s section already filled out, an official photo ID (passport or U.S. driver’s license), a complete vaccination record with all received doses, and payment for the exam.
Costs vary significantly between different Civil Surgeons and depend on the required laboratory tests and vaccines. It is advisable to research and compare prices among accredited doctors in the same area before scheduling the appointment. Most health insurance plans do not cover the immigration medical exam, as it is not classified as clinical treatment.
Validity and submission rules
The validity rules for the I-693 Form have undergone significant changes in recent years. According to the policy in effect since June 2025, an I-693 signed by the Civil Surgeon on or after November 1, 2023, remains valid as long as the application with which it was submitted is pending. If the application is denied or withdrawn, the I-693 loses its validity. This rule replaced the previous policy that granted the document a fixed validity of two years.
After the exams are completed, the Civil Surgeon fills out and signs the form, placing it in a sealed envelope. This envelope must not be opened by the applicant under any circumstances; if the seal is broken, the form will be invalidated. The document must be included in the I-485 submission package exactly as delivered by the doctor.
For forms using the latest edition, USCIS only accepts the 01/20/25 edition for forms signed on or after July 3, 2025. It is essential to confirm with the Civil Surgeon that the correct edition of the form is being used before the appointment.
Frequently asked questions
Missing vaccines
If the applicant does not have all required vaccines, the Civil Surgeon can administer them during the appointment or prescribe them to be taken elsewhere. Missing vaccines are extremely common and do not harm the immigration process, as long as they are completed before the I-693 is finalized.
Chronic conditions and the Green Card
Chronic medical conditions such as diabetes, hypertension, or asthma generally do not prevent Green Card approval. Inadmissibility on health grounds under INA § 212(a)(1) applies to a specific set of conditions: communicable diseases of public health significance, failure to provide proof of vaccination, mental or physical disorders associated with behavior that poses a threat, and dependence on controlled substances. Chronic conditions under medical control do not fall into these categories.
Health insurance coverage
Most health insurance plans in the United States do not cover the immigration medical exam, as it is not classified as clinical treatment. Costs vary considerably between different Civil Surgeons and depend on the required laboratory tests and vaccines. It is advisable to research prices among different accredited doctors in the same area before scheduling the appointment.
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.
