The I-485 medical exam isn't just a formality, missing vaccines, incomplete documentation, or working with a non-designated doctor can delay or derail your case. Here's everything you need to know.
Form I-693, Report of Medical Examination and Vaccination Record, is the official document that records your green card medical examination results. It must be completed by a USCIS-designated civil surgeon, a licensed physician authorized by USCIS to perform immigration medical exams.
The purpose of the medical exam is to screen for communicable diseases of public health significance, mental disorders associated with harmful behavior, and drug addiction, all of which can make a person inadmissible to the US. The exam also confirms that you've received required vaccinations per the CDC immunization schedule.
| Test/Check | Details |
|---|---|
| Physical examination | General health assessment, cardiovascular, respiratory, neurological, etc. |
| Tuberculosis (TB) screening | Skin test (TST) or blood test (IGRA). Positive result requires chest X-ray. Active TB must be treated. |
| Syphilis (VDRL) | Blood test for syphilis. Active untreated syphilis is Class A inadmissible. |
| Gonorrhea testing | For applicants 15+ years old |
| Mental health evaluation | History review and clinical assessment. Must identify disorders with harmful behavior. |
| Substance abuse screening | History of drug/alcohol abuse or addiction is assessed. |
| Vaccination review | Review of vaccination records; missing vaccines administered at the appointment. |
| Hansen's disease (leprosy) | Screening for this rare but monitored condition. |
The CDC Advisory Committee on Immunization Practices (ACIP) schedule determines required vaccines. As of 2026, the list includes:
Note: If you have documentation of prior vaccination or immunity (blood titers), the civil surgeon may accept this instead of revaccination. Bring all vaccination records to your appointment.
Only USCIS-designated civil surgeons can complete Form I-693. Find one at uscis.gov/civils or through a Google search for "USCIS civil surgeon [your city]." Costs range from $200–$600 depending on required vaccines and location, call ahead to get a quote.
Bring to your appointment:
Since 2020, Form I-693 signed by a civil surgeon is valid for 4 years from the civil surgeon's signature date. However, USCIS must adjudicate your I-485 while the I-693 is still valid. If your case sits pending for more than 4 years after the medical exam, you may need a new exam. This is a real risk for applicants in long-backlogged categories (EB-India, EB-China), some immigration attorneys recommend delaying the medical exam until later in the process.
Sumit covers the I-485 adjustment of status process including medical exam requirements, helping applicants understand every step of the green card application process.