The green card medical exam (Form I-693): what it involves and when to file it

What is the I-693 medical exam, and when do you file it? Form I-693, Report of Immigration Medical Examination and Vaccination Record, is how an adjustment of status applicant shows USCIS they are not inadmissible on health grounds. In general, only a USCIS-designated civil surgeon can complete it. Since December 2, 2024, USCIS requires you to submit it with your Form I-485, the green card application filed inside the United States, and says it may otherwise reject the I-485. A form signed on or after November 1, 2023 is generally valid only for the application it was filed with. If you are processing abroad through a consulate, a panel physician does the exam instead.

What does the law require?

The health grounds are in INA 212(a)(1). They make inadmissible a person with a communicable disease of public health significance, a person seeking to immigrate or adjust status who "has failed to present documentation of having received vaccination against vaccine-preventable diseases," a person with certain physical or mental disorders with harmful behavior, and a person found to be a drug abuser or addict (INA 212(a)(1)(A), 8 U.S.C. 1182 (Cornell LII)). The statute says inadmissible people are ineligible for visas and for admission, and USCIS requires adjustment applicants to show they are not inadmissible on these grounds, usually through Form I-693 (USCIS Policy Manual, Volume 8, Part B, Chapter 4). Waivers exist for some findings but not all.

The regulation on adjustment of status turns that into an exam requirement:

"Pursuant to section 232(b) of the Act, an applicant for adjustment of status shall be required to have a medical examination by a designated civil surgeon, whose report setting forth the findings of the mental and physical condition of the applicant, including compliance with section 212(a)(1)(A)(ii) of the Act, shall be incorporated into the record." 8 CFR 245.5

(8 CFR 245.5)

Health and Human Services rules sort findings into Class A conditions, which make a person inadmissible, and Class B conditions, which do not (Form I-693 instructions, edition 01/20/25; 42 CFR 34.2).

Who can do the exam?

Only a civil surgeon, meaning "A physician designated by DHS to conduct medical examinations of aliens in the United States who are applying for adjustment of status to permanent residence or who are required by DHS to have a medical examination" (42 CFR 34.2(c)). Apart from physicians who are Public Health Service officers, USCIS says only designated civil surgeons may conduct the exam in the United States and complete Form I-693; only licensed doctors of medicine (M.D.) or osteopathy (D.O.) may be designated, and the doctor must hold the designation when the exam is completed (USCIS Policy Manual, Volume 8, Part B, Chapter 4). Your own family doctor cannot sign the form unless they are designated. USCIS links a Find a Civil Surgeon tool from its Form I-693 page.

There is no USCIS filing fee for Form I-693 (Form G-1055, edition 10/07/26). The exam itself is not free: USCIS says fees "are established by the civil surgeon" and may vary (USCIS, Form I-693), and that it does not regulate what civil surgeons charge (USCIS, Vaccination Requirements). In practice, ask two or three civil surgeons for a full price, including tests and any vaccines, before you book.

What does the exam involve?

The Form I-693 instructions describe the main parts (Form I-693 instructions):

• Identity check. Bring a valid government-issued photo ID, such as an unexpired passport or driver's license.
• Tuberculosis (TB). Everyone aged 2 or older gets an initial screening test. A positive result leads to a chest X-ray, and an X-ray suggestive of TB leads to a health department referral.
• Syphilis and gonorrhea. Testing follows the age ranges in the CDC Technical Instructions for Civil Surgeons. The civil surgeon also evaluates for other sexually transmitted diseases and Hansen's disease (leprosy).
• Physical or mental disorders. A disorder alone does not make you inadmissible; there must also be associated harmful behavior, current or likely to recur.
• Drug abuse or addiction. The civil surgeon reviews your history and asks about current and past use of drugs and other psychoactive substances.
• Vaccination review. Covered in the next section.

The civil surgeon may sign only after the whole exam is done, including any required treatment for a Class A condition (Policy Manual, Volume 8, Part B, Chapter 4).

Which vaccinations are required?

The statute lists mumps, measles, rubella, polio, tetanus and diphtheria toxoids, pertussis, "influenza type B" and hepatitis B, plus other vaccinations recommended by the Advisory Committee on Immunization Practices (ACIP) (INA 212(a)(1)(A)(ii), 8 U.S.C. 1182 (Cornell LII)). USCIS lists the influenza entry as Haemophilus influenzae type B (USCIS, Vaccination Requirements). CDC decides which ACIP vaccines to require, using two tests: the vaccine must be age-appropriate for the general US population, and it must protect against a disease that could cause an outbreak or that has been, or is being, eliminated in the United States (CDC, Vaccination Technical Instructions for Civil Surgeons).

What USCIS says in practice (USCIS, Vaccination Requirements, updated 07/08/2025):

• Bring your records. The civil surgeon reviews written vaccination records; CDC says "Self-reported vaccine doses without written documentation are not acceptable" (CDC). Written proof of immunity, such as lab results, also helps.
• One dose per visit. You need a single dose of each missing vaccine at the exam, not the full series.
• Only age-appropriate vaccines. Vaccines that do not fit your age, or that are medically contraindicated, are annotated on the form.
• Flu season. The civil surgeon must give the flu vaccine from September 1 to March 31.
• COVID-19. Not required for any adjustment application pending on or after January 20, 2025.
• Objections. A waiver is available only if you oppose all vaccinations, on sincere religious or moral grounds. For I-140-based cases, the waiver form is Form I-601.

When must Form I-693 be filed?

With the I-485. USCIS states the rule directly:

"Effective Dec. 2, 2024, you must submit Form I-693, or a partial Form I-693 (such as the Vaccination Record), and you must submit it with your Form I-485. Otherwise, we may reject your Form I-485." USCIS, Form I-693 page

(USCIS, Form I-693, updated 07/24/2026)

How you submit depends on how you file (USCIS, Form I-693):

• Paper I-485: include the I-693 in the original sealed envelope from the civil surgeon. USCIS says not to accept the form if it is not sealed.
• Online I-485: open the envelope, upload the completed I-693, and keep the original form and envelope until USCIS decides your case, because USCIS may ask for them or review them at an interview.

The current edition is 01/20/25. If the civil surgeon signs on or after July 3, 2025, USCIS accepts only that edition. USCIS also says that, in general, you may not file Form I-485 until an immigrant visa is immediately available in your category, which for employment-based cases depends on your priority date (USCIS, Form I-485). Our guide to the I-485 in practice covers the rest of the package.

How long is a Form I-693 valid?

The Policy Manual ties a recent I-693 to one application:

"USCIS has determined that, in general, a properly completed Form I-693 that is signed by a civil surgeon on or after November 1, 2023 can only be used as evidence to show that the applicant is not inadmissible under the health-related grounds for the entire period the immigration benefit application with which the Form I-693 is submitted is pending." USCIS Policy Manual, Volume 8, Part B, Chapter 4

The same section adds: "If the immigration benefit application with which the Form I-693 is submitted is withdrawn or denied, then an applicant needs to submit a newly completed and signed Form I-693 with any future immigration benefit application" that requires one. A form signed before November 1, 2023 "retains evidentiary value for 2 years from the date of the civil surgeon’s signature." An officer who has reason to think your health has changed may still ask for a new or updated form (USCIS Policy Manual, Volume 8, Part B, Chapter 4).

This replaced an earlier rule. The Policy Manual notes that from April 4, 2024 until June 11, 2025, forms signed on or after November 1, 2023 were valid indefinitely; the June 11, 2025 policy alert limited validity to the application the form supports. One helpful rule remains: officers review the form against the CDC instructions in force on the date the civil surgeon signed it, and "should not issue a Request for Evidence (RFE)" for requirements that did not apply on that date (Policy Manual, Volume 8, Part B, Chapter 4).

What this means in practice: schedule the exam when you are close to filing the I-485, not months earlier, and expect to need a new exam if an I-485 is denied or withdrawn and you file again. If USCIS rejects a package and returns it with the envelope opened, the I-693 page says you may refile with the original opened form and a copy of the rejection notice.

What happens if you process abroad instead?

If you get your green card through consular processing, the exam happens abroad with a panel physician, "A physician selected by a United States embassy or consulate to conduct medical examinations of aliens applying for visas" (42 CFR 34.2(o)). The State Department regulation requires the exam for every immigrant visa applicant:

"Before the issuance of an immigrant visa, the consular officer shall require every alien, regardless of age, to undergo a medical examination in order to determine eligibility to receive a visa." 22 CFR 42.66(a)

The applicant chooses the doctor from the consulate's approved panel (22 CFR 42.66(b)). Panel physicians record results on Form DS-7794 or DS-2054, not on Form I-693, and follow CDC's separate instructions for panel physicians (Policy Manual, Volume 8, Part B, Chapter 4; USCIS, Vaccination Requirements). Our post on what happens after your I-140 is approved compares the two routes.

Where to start

In practice, find two or three civil surgeons near you, compare prices, and gather your vaccination records now. Book the exam for when your I-485 is nearly ready, so the sealed I-693 can go in the same package. Check the edition and the envelope before you mail.

The medical belongs to the last stage of an employment-based green card. If you are earlier in the process, the free evaluation checks your record against EB-1A, EB-2 NIW and O-1, with no account or card, and Frank helps you build missing evidence; Frank Starter is $49 a month with a 7-day free trial. Licensed attorneys at our independent partner firm handle the petitions (EB-2 NIW from $7,995, EB-1A from $8,995, USCIS fees separate). Green Card Guide is not a law firm, this is not legal or medical advice, and questions about a specific medical finding belong with the civil surgeon or a licensed immigration attorney.

Sources

All checked October 14, 2026.

• INA 212(a)(1), 8 U.S.C. 1182 (Cornell LII). Health-related grounds of inadmissibility.
• eCFR, 8 CFR 245.5. Medical exam for adjustment of status, quoted above.
• eCFR, 42 CFR 34.2. Definitions of civil surgeon, panel physician and Class A and B conditions.
• eCFR, 22 CFR 42.66. Medical exam for immigrant visas, quoted above.
• USCIS, Form I-693 (updated 07/24/2026). Filing with the I-485, edition, sealed envelope and online upload, quoted above.
• USCIS, Form I-485 (updated 10/07/2026). Visa availability before filing, and the I-693 filing requirement.
• Form I-693 instructions (edition 01/20/25). Identity, tests, health grounds and Class A and B conditions.
• USCIS Policy Manual, Volume 8, Part B, Chapter 4. Civil surgeon designation, validity and the June 11, 2025 policy alert, quoted above.
• USCIS, Vaccination Requirements (updated 07/08/2025). Required vaccines, single doses, flu season, COVID-19 and waivers.
• CDC, Vaccination Technical Instructions for Civil Surgeons (updated March 11, 2025). Criteria for required vaccines and documentation.
• USCIS, Form G-1055 Fee Schedule (edition 10/07/26). No USCIS fee for Form I-693.

Frequently asked questions

Green Card Guide AI is not a law firm and this article is not legal advice. It describes evidence-building strategy in general terms; your attorney determines what belongs in your petition and how it's argued.