If you are applying for a green card from inside the United States, you will run into Form I-693 sooner or later. It is officially called the Report of Immigration Medical Examination and Vaccination Record, and honestly, the name alone scares off a lot of people. But once you break it down, it is just a health check and a vaccine record review done by a doctor the government trusts.
This guide walks through what the form actually is, who has to file it, what happens during the exam, and how the rules have changed recently. USCIS has updated its policy on this form more than once in the last couple of years, so even if you read about it before, some details may be different now.
Form I-693 Quick Reference
If you just need the short version before diving in, here it is.
| What is it? | USCIS Report of Immigration Medical Examination and Vaccination Record |
|---|---|
| Who needs it? | Most green card applicants filing from inside the U.S. (Form I-485 filers) |
| Who completes it? | A USCIS-designated civil surgeon, not your regular doctor |
| Validity | Tied to the specific I-485 it is filed with, for forms signed on or after November 1, 2023. Forms signed earlier are valid for two years from the signature date |
| Cost | Typically $200 to $600, depending on the civil surgeon and any vaccines or lab work needed |
| When to file it | Submitted together with Form I-485, not separately, as of December 2, 2024 |
| Where to download the form | USCIS Form I-693 page |
What Is Form I-693 and Why Does USCIS Need It
Form I-693 exists because U.S. immigration law says certain health conditions can make someone inadmissible. That sounds harsh, but in practice it mostly covers a short list of communicable diseases, missing vaccinations, and a few mental health or substance abuse situations. USCIS is not trying to disqualify healthy people. They just need proof, from a doctor they approve, that you do not fall into one of those categories.
The form has to be completed by a USCIS-designated civil surgeon, not just any doctor. This matters more than people realize. Your regular family physician, even if they are wonderful, cannot sign this form unless they have gone through the USCIS designation process. USCIS keeps an official list of approved civil surgeons searchable by ZIP code, and it is worth checking that list early if you are still working through your adjustment of status filing, since scheduling can take a few weeks in some areas.
Who Actually Needs to Submit It
Most people applying for adjustment of status, meaning they are filing Form I-485 while already in the U.S., need to submit Form I-693. This includes family-based applicants, employment-based applicants, and several other categories. There are a few exceptions, like certain refugees or asylees who already completed a medical screening overseas, but those are less common.
If you are applying for a green card from outside the U.S. instead, the form and the doctor you see are both different.
Adjustment of Status vs Consular Processing: What Changes
This mix-up confuses a lot of families, especially when one spouse is applying from inside the U.S. while a relative overseas is going through consular processing instead. The medical exam is required in both situations, but who performs it, what it is called, and where it gets submitted are not the same.
| Features | Adjustment of Status (inside the U.S.) | Consular Processing (outside the U.S.) |
|---|---|---|
| Form used | Form I-693 | DS-3025 and related consular medical forms |
| Doctor who performs it | USCIS-designated civil surgeon | Embassy-approved panel physician |
| Where it gets submitted | With Form I-485, to USCIS | Directly to the U.S. embassy or consulate |
| Validity | Tied to the specific I-485 filing | Set by the embassy, often a shorter window |
If you had a medical exam overseas through a panel physician and later apply for adjustment of status in the U.S. for a different reason, USCIS does not always accept the old results. In most cases, you will still need a civil surgeon to review your vaccination records and complete a new Form I-693, even if you were examined before.
What Happens During the Medical Exam
A lot of applicants show up nervous, worried the exam will be invasive or embarrassing. It is really just a routine physical, plus a records check. The civil surgeon reviews your medical history, checks your vaccination records, runs a basic physical exam, and orders a few lab tests depending on your age.
Here is roughly what to expect at the appointment:
- A review of your general health history and any past illnesses
- A physical exam covering vision, hearing, and basic body systems
- Blood tests, which usually include screening for a few specific conditions
- A chest X-ray or TB skin test if you are old enough to require it
- A review of your vaccination records against the CDC’s required list
- Any missing vaccines administered on the spot, unless there is a medical reason not to
Bring every vaccination record you have, even old ones from childhood. Titer blood tests can sometimes prove immunity if paper records are missing, which saves you from getting a shot you may not actually need.
Vaccination Requirements in 2026
The vaccine part of the exam causes more headaches than the physical exam does. USCIS follows CDC guidance here, and the required vaccines depend heavily on your age. A couple of the rules changed in the last two years, so if you read about this before 2024, some of what you remember is probably out of date.
| Vaccine | Typically Required For |
|---|---|
| MMR (measles, mumps, rubella) | Most applicants, 2 doses |
| Tdap (tetanus, diphtheria, pertussis) | Adults, with boosters every 10 years |
| Polio (IPV) | Anyone 2 months or older not already up to date, at least 1 dose |
| Varicella (chickenpox) | Applicants without documented immunity |
| Hepatitis A and B | Age-dependent, adults 60 and older no longer need Hep B |
| Meningococcal (MenACWY) | Adolescents and certain other age groups |
| Influenza | Only required during flu season, September through March |
| Pneumococcal | Adults 65 and older |
The polio rule is one to watch closely. As of May 1, 2024, CDC guidance requires at least one dose of the inactivated polio vaccine for anyone age 2 months or older who cannot show they are already up to date, even adults who never had the full childhood series. This applies to any Form I-693 signed on or after that date, so do not assume an old polio record from years ago automatically satisfies the current rule.
COVID-19 vaccination is no longer a requirement, as of January 20, 2025 for applicants inside the U.S. and March 11, 2025 for consular cases. If your civil surgeon marks a vaccine as “not medically appropriate” or “not age appropriate,” that is a valid finding and will not hurt your application, as long as it is documented properly on the form.
How Long Is Form I-693 Valid For
This is where things get a little confusing, because the rule has changed a few times recently. As of June 2025, USCIS tied the validity of Form I-693 directly to the specific application it was filed with. In plain terms, if your Form I-693 was signed by a civil surgeon on or after November 1, 2023, it stays valid only while the I-485 it was submitted with is still pending. If that application gets denied or withdrawn, the medical exam is no longer valid, and you will need a new one for any future filing.
If your form was signed before November 1, 2023, the older rule applies, and it is generally valid for two years from the signature date. Since December 2024, USCIS also expects the completed I-693 to be submitted together with your Form I-485, not filed separately weeks later. This is a change from the old approach where some applicants filed the medical exam after the initial application. Because these rules shift often, it is worth double checking your timeline with an immigration attorney or your civil surgeon’s office before you file, especially if you are getting close to your interview date.
Common Mistakes That Cause Delays
A poorly filled out I-693 is one of the more avoidable reasons people get a Request for Evidence from USCIS. Most of these mistakes are small, but they add months to processing time when they happen.
- Using a doctor who is not a USCIS-designated civil surgeon
- Opening the sealed envelope before submission, which can void the exam
- Missing signatures or incomplete sections on the form
- Submitting an outdated version of the form after USCIS releases a new edition
- Leaving out vaccination records the civil surgeon needed to review
- Filing the I-693 separately instead of with the I-485 package
If your civil surgeon gives you a sealed envelope, leave it sealed. USCIS wants that seal intact when they receive it, and a broken seal can force you to redo the whole exam.
Special Scenarios Worth Knowing About
Not everyone fits the standard process. A few situations come up often enough that they are worth walking through on their own.
- Pregnant applicants: Some vaccines, like MMR and varicella, are not given during pregnancy because they contain live virus. The civil surgeon will note this on the form as a valid deferral rather than a missing vaccine, and you can complete it after delivery. This does not delay your green card decision on its own.
- Children and minors: Vaccine requirements for kids follow a different CDC schedule than adults, based on age rather than a flat list. Younger children may also be exempt from certain tests, like the chest X-ray, that are standard for adults. Parents should still bring whatever vaccination records the school or pediatrician has on file, since it saves time at the appointment.
- Applicants with a prior overseas medical exam: If you already went through a panel physician exam abroad, maybe for a K-1 fiancé visa or a prior application, USCIS does not automatically treat that as good enough for adjustment of status. A civil surgeon in the U.S. usually still needs to review your history and complete a fresh Form I-693, though your old vaccination records can reduce how many shots you need again.
Getting Ready for Your Appointment
A little preparation goes a long way here. Bring the following to your appointment:
- Vaccination records, including old ones from childhood, since this is usually the part that takes the longest to sort out if something is missing
- A government-issued photo ID, like a passport or driver’s license
- Any prior immigration medical records, if you have had an exam before for a different application
- A written list of past surgeries, chronic conditions, or medications you are currently taking
- Your A-number, if you have one, so it can be checked against the form
The civil surgeon will ask about your medical history directly, and having the information written down ahead of time speeds things up. If you have questions about how your specific health history might affect your application, it is worth discussing that with your attorney before the appointment rather than after.
Getting Your Medical Exam Right the First Time
You do not need to stress over Form I-693. The exam itself is usually quick, and most applicants pass without any complications. What actually causes trouble is the paperwork around it: the wrong doctor, a missing vaccine record, or filing it separately from your I-485 out of habit. Find a properly designated civil surgeon, bring your full vaccination history, and file the form alongside your I-485.
If you are getting ready to start your adjustment of status case and want help making sure every piece of your application lines up correctly, reach out to the team at American Dream Immigration for guidance on the next steps.
Frequently Asked Questions
Can my regular doctor sign Form I-693?
No, unless your doctor has been specifically designated by USCIS as a civil surgeon. A regular license to practice medicine is not enough on its own.
What happens if I fail the medical exam?
Very few people fail outright. Most issues, like a missing vaccine or an incomplete TB test, can be corrected before or after submission with follow-up documentation.
Do I need to redo my medical exam if my green card case was denied?
Yes, in most cases. Since the 2025 policy update, a Form I-693 is generally tied to the specific application it was filed with, so a denial or withdrawal usually means a new exam is needed for future filings.
Is a chest X-ray required for everyone?
Not always. It usually depends on your age and your TB skin test or blood test results. Younger children are often exempt from the X-ray requirement.
Can I submit Form I-693 separately from my I-485?
It is not recommended anymore. Since December 2024, USCIS generally expects the medical exam to be submitted together with your I-485 package to avoid rejection.