The immigration medical exam (Form I-693) is required for green card applicants. Learn who needs it, how to find a civil surgeon, required vaccines, validity, and submission rules.
The immigration medical examination is a physical examination conducted by a USCIS-designated physician called a "civil surgeon" (in the United States) or a "panel physician" (at US embassies and consulates abroad). The exam is required for most green card applicants, both those adjusting status inside the US and those going through consular processing abroad. The results are documented on Form I-693 (Report of Medical Examination and Vaccination Record).
The purpose of the medical exam is to screen for health conditions that are grounds of inadmissibility under US immigration law. These include communicable diseases of public health significance (such as active tuberculosis), failure to have required vaccinations, certain mental health conditions with associated harmful behavior, and drug abuse or addiction. USCIS and the CDC work together to define what conditions trigger inadmissibility and what documentation is required.
For adjustment of status applicants (those already in the US), the civil surgeon is the only authorized physician to complete Form I-693. You cannot use your personal doctor or any other physician, they must be on the USCIS civil surgeon list. USCIS maintains a searchable list of designated civil surgeons on its website. There are thousands of civil surgeons across the country, and in most metropolitan areas multiple options are available. Fees typically range from $200 to $600 or more depending on the physician and any additional tests needed.
For consular processing applicants (applying for an immigrant visa at a US embassy or consulate), the exam is conducted by a panel physician designated by the embassy in the applicant's home country. The process is similar but administered by the embassy rather than USCIS. The panel physician submits results directly to the embassy, and the applicant receives a sealed envelope to bring to the visa interview. Unlike adjustment of status, consular processing applicants may need to undergo an updated medical exam if their visa is not used within a certain period.
US immigration law requires applicants to have vaccinations against a specified list of vaccine-preventable diseases. As of 2025, the required vaccines include: influenza type b (Hib), hepatitis A, hepatitis B, human papillomavirus (HPV) for applicable age groups, inactivated polio vaccine, influenza (seasonal), measles, meningococcal, mumps, pneumococcal, rotavirus, rubella, tetanus/diphtheria/pertussis (Tdap), varicella (chickenpox), and COVID-19. The specific requirements depend on the applicant's age, not all vaccines are required for all age groups.
If the applicant has documentation of prior vaccination (vaccination records, immunization history from a doctor), those records can be presented to the civil surgeon to demonstrate existing immunity. For vaccines where immunity can be documented through titer tests (blood tests measuring antibody levels), some civil surgeons accept titer results as proof of immunity for certain vaccines like measles, mumps, rubella, and varicella. This can save significant cost if the applicant has already received vaccinations but cannot locate records, titer tests can confirm immunity without requiring repeat vaccination.
Beyond vaccinations, the civil surgeon conducts a physical examination covering general health, mental health, and specific disease screening. A tuberculosis (TB) test is required for all applicants, either a tuberculin skin test (TST) or an interferon-gamma release assay (IGRA blood test). Chest X-rays are required for applicants who test positive for TB exposure or who are over 15 years old in certain circumstances. Testing for syphilis is required for applicants 15 and older. Testing for gonorrhea is required for certain applicants based on history and risk factors. The civil surgeon also screens for drug use and mental health conditions that could constitute grounds of inadmissibility.
The civil surgeon documents all findings on Form I-693, which includes two sealed envelopes, one containing the completed I-693 and one containing the vaccination record (Form I-693 Supplement B). The civil surgeon signs and seals these envelopes and provides them to the applicant. Applicants must not open the sealed envelopes, doing so invalidates the medical exam results and will require a new examination. The sealed documentation is then submitted to USCIS as directed in the current instructions for the application type.
USCIS maintains a Civil Surgeon Locator tool on its website (uscis.gov) that allows applicants to search for designated civil surgeons by zip code. The search results include the physician's name, address, phone number, and in some cases a website. Not all civil surgeons accept all types of insurance, and many require payment out of pocket, so it is worth calling ahead to understand costs and what to bring. USCIS does not set fees for civil surgeon examinations, so prices vary widely by location and provider.
When scheduling the exam, ask the civil surgeon's office what documentation to bring. Standard items include: government-issued photo ID (passport preferred), any vaccination records or immunization history, medical records for any ongoing health conditions or past diagnoses that might be relevant, and information about any current medications. Bringing complete vaccination records can significantly reduce the cost of the exam by avoiding unnecessary repeat vaccinations. Some civil surgeons can complete the entire exam in one visit; others may require multiple visits if additional tests are needed.
Cost management is a real concern for many applicants. The examination fee alone can be several hundred dollars, and required vaccinations can add significantly to the cost, particularly if the applicant needs multiple vaccines and does not have prior documentation. Some community health centers and public health departments offer civil surgeon services at reduced cost. Applicants who are fee waiver eligible (for the underlying I-485 application) should check whether they also qualify for any assistance with medical exam costs, though USCIS does not generally waive medical exam fees directly.
Once the examination is complete, the civil surgeon provides the sealed Form I-693 package. Applicants should store this in a safe place until they are ready to submit it to USCIS. The sealed envelope should be kept at room temperature, avoid extreme heat or cold that could damage the documentation. If the sealed envelope is accidentally opened, damaged, or lost, the applicant must return to the civil surgeon for a new examination. Some civil surgeons keep copies on file for a period of time, which can help if a minor issue arises, but a new sealed package will generally be needed if the original is compromised.
Since procedural changes implemented by USCIS in recent years, Form I-693 can be submitted directly with the Form I-485 package or separately at any time before USCIS adjudicates the case. Previously, the standard practice was to bring the sealed I-693 to the USCIS interview, but USCIS now accepts early submission and may issue an RFE requesting the I-693 if it is not received in time. Applicants should check the current I-485 instructions on the USCIS website for the most up-to-date submission procedures, as these can change.
The validity period of Form I-693 is two years from the date the civil surgeon signed it. USCIS must receive the results within this two-year window, and the results must still be within the validity period at the time USCIS adjudicates the case. If significant time passes between filing the I-485 and the interview (which can happen when there are visa backlogs or case delays), the I-693 may expire before adjudication. In that case, USCIS will issue an RFE requesting a new medical examination. Applicants in long-pending cases should monitor their I-693 validity date proactively.
Medical findings that indicate inadmissibility grounds require action. If the civil surgeon finds active tuberculosis, USCIS will require treatment before the green card can be issued. If vaccination requirements are not met (and no waiver applies), USCIS will issue an RFE requesting vaccination records or documentation of vaccination completion. Certain mental health conditions and substance use disorders require additional documentation and may require evaluation by a specialist designated by the civil surgeon. Applicants with complex medical histories should work with an immigration attorney to understand how findings might affect their case before the exam.
Waivers of medical grounds of inadmissibility are available in some cases. Form I-601 (Application for Waiver of Grounds of Inadmissibility) can be filed for certain medical grounds, particularly where the applicant has a qualifying family member who would suffer extreme hardship if the waiver is denied. Waivers for TB classes are handled differently, they typically require a treatment plan and certification. Vaccination requirement waivers are available on religious or moral grounds (Form I-601) or medical contraindication grounds (documented by the civil surgeon on the I-693 itself). An immigration attorney can assess whether a waiver is viable given the specific facts.
Refugee and asylee applicants who obtained status after completing an overseas medical examination may have a partial or complete waiver of the medical exam requirement for adjustment of status, depending on when the overseas exam was completed and what it covered. Similarly, certain Special Immigrant categories and Violence Against Women Act (VAWA) self-petitioners may have modified medical exam requirements. Applicants in these categories should review the specific instructions for their adjustment category before scheduling an exam.
Children under age 14 have modified requirements, some vaccines are age-based and not required for young children, while others have pediatric dosing schedules. Parents bringing minor children to the civil surgeon should bring complete vaccination records from the child's pediatrician. This can save significant time and cost. Civil surgeons will verify immunization records and administer only vaccines needed to complete the required schedule. If a child has special medical needs, it may be worth calling the civil surgeon's office ahead to discuss accommodations.
Common mistakes in the medical exam process include: using a physician who is not a designated USCIS civil surgeon (invalidating the exam), opening the sealed envelope before submission (invalidating the exam), waiting so long to schedule that the I-693 expires before adjudication, failing to bring vaccination records and paying for unnecessary vaccinations, and submitting an I-693 with a civil surgeon's signature date that is too old. Applicants should also double-check that the civil surgeon has completed all required fields, an incomplete I-693 will result in an RFE and delay.
Finally, privacy concerns occasionally come up. The medical information on Form I-693 is sensitive, it includes vaccination history, TB test results, blood test results, and potentially mental health information. USCIS is bound by the Privacy Act with respect to this information, and it is used only for immigration adjudication purposes. Applicants sometimes worry that medical findings will appear in databases accessible to employers or law enforcement. In general, immigration medical records are used only for immigration purposes and are not shared beyond USCIS and relevant immigration authorities. Applicants with specific privacy concerns should consult an attorney.
Our attorneys guide clients through every step of the green card process, including the medical examination. We have experience handling complex medical inadmissibility issues and waiver applications.