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Anyone seeking to adjust status in the United States and obtain a Green Card through a petition filed domestically must meet a requirement reinforced by USCIS since December 2, 2024: Form I-693, which documents the immigration medical examination and vaccination record, must now be submitted concurrently with Form I-485. This change ends the previous practice of submitting the medical exam at a later point, typically in response to a Request for Evidence (RFE), and directly impacts the timeline and strategy of anyone in the adjustment of status process.
The change does not alter the medical requirements themselves, but rather the procedural moment at which the documentation must be ready. For applicants going through consular processing outside the United States, the medical exam continues to be performed by panel physicians designated by the Department of State, in a separate process. This new USCIS rule specifically affects those already in the United States who are filing for domestic adjustment of status.
What Is Form I-693
Form I-693, officially the Report of Immigration Medical Examination and Vaccination Record, is the document that demonstrates to the U.S. government that a Green Card applicant does not pose a public health risk. It can only be completed by a USCIS-authorized physician known as a civil surgeon, and must be delivered to the applicant in a sealed envelope. The applicant must not sign the self-declaration section before the appointment.
The exam covers four main areas: screening for communicable diseases of public health significance (tuberculosis, syphilis, gonorrhea, and Hansen’s disease), vaccination history and updates for immigration-required vaccines, substance use evaluation, and mental health screening for disorders that may involve harmful behavior. The complete immunization checklist includes vaccines such as MMR, Tdap, varicella, hepatitis A and B, seasonal influenza, pneumococcal (age-dependent), and the COVID-19 vaccine, the latter subject to current CDC guidelines.
What Changed in Practice
Before the new directive, it was standard practice to file Form I-485 without the medical exam and submit Form I-693 later, within the timeframe granted in an RFE. That window allowed applicants to schedule the exam at their convenience and defer the cost. Now, the package must be complete at the time of initial submission. Filing Form I-485 without Form I-693 may result in an outright rejection of the petition, with the entire package returned and the need to refile from scratch, forfeiting the original filing date and repaying all fees.
The impact on the priority date can be critical in oversubscribed Visa Bulletin categories, where a difference of just a few days can push a case to a subsequent bulletin. For EB-2, EB-3, and family-based categories with frequent retrogression, losing the effective filing date is sufficient reason to treat Form I-693 as a critical element of the application package.
Why USCIS Tightened the Rule
The official USCIS rationale cites three objectives. First, to reduce the volume of RFEs issued solely to request the medical exam, which historically represented a significant share of pending cases. Second, to shorten the average adjudication time for adjustment of status, which currently spans several months depending on the field office. Third, to align the domestic process with the consular process, where the medical exam has long been a prerequisite for the interview.
For the applicant, this means an earlier outlay of cost and logistics. A civil surgeon exam typically costs between $200 and $600, depending on the region, the number of outstanding vaccines, and whether laboratory tests such as the tuberculosis IGRA test are included. These costs are non-refundable by USCIS and are not part of the filing fee.
How to Meet the Requirement
The first step is to locate an authorized civil surgeon. USCIS maintains an official search tool at uscis.gov/tools/find-a-civil-surgeon, organized by ZIP code. Only professionals listed in that database are credentialed to issue Form I-693. General practitioners or non-credentialed immigration clinics are not acceptable, even if they perform clinically equivalent exams.
- Schedule the appointment at least 4 to 6 weeks before the planned I-485 filing date, accounting for the fact that some vaccines require intervals between doses.
- Bring a complete vaccination record (translated when possible), relevant medical records, and a photo ID. A full vaccination history can prevent duplicate doses the exam might otherwise require.
- Receive Form I-693 in a sealed envelope and do not open it under any circumstances. USCIS rejects reports whose seal has been broken, even if opened out of curiosity.
- Include the intact envelope in the I-485 package and keep a scanned copy of the form for your personal records before the physician seals it.
Validity of the Exam
Form I-693 is valid for up to two years from the date the civil surgeon signs the document, under the policy in effect since November 2023. Prior to that update, validity was calculated differently, causing frequent confusion. Today, it is sufficient that the physician’s signature falls within the two-year window at the time of USCIS’s final decision on the I-485 for the exam to be accepted.
Special Scenarios
Those who filed Form I-485 before December 2, 2024, without the medical exam remain under the previous rule and may submit Form I-693 in response to an RFE when one is issued. The new requirement applies to petitions received by USCIS on or after the effective date. Refugees and asylees adjusting status under specific statutory provisions follow partially different rules, but the logic of concurrent submission now applies to them as well.
For children under 14, the scope of the exam is reduced, waiving certain laboratory tests. The overall cost tends to be lower, but Form I-693 remains mandatory in the package.
Mistakes That Can Cost You
The most common errors seen in I-485 packages involve the envelope seal. Anxious applicants open the document to review its contents or make a copy after the physician has already sealed it. Any evidence of tampering invalidates the report and requires a new exam, with new costs and a new waiting period.
Another frequent mistake is submitting a form issued by a physician not credentialed by USCIS. Even if the professional is otherwise qualified, without civil surgeon registration Form I-693 has no validity. Before scheduling an appointment, confirm the physician’s credentials using the official USCIS tool.
Finally, it is common to underestimate the time needed to complete outstanding vaccines. The hepatitis B vaccine series, for example, follows a three-dose protocol spread over six months. Cases with incomplete vaccination may use the blanket waiver option or complete the series during the process, but this depends on a case-by-case assessment by the civil surgeon.
Treating Form I-693 as a key strategic element, not as secondary paperwork, is no longer optional. In an environment where USCIS is working to accelerate adjudications and penalize incomplete packages, the medical exam has become just as central as the financial documentation of the affidavit of support or the eligibility evidence for the category being sought.
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.
