The Green Card Medical Exam and Form I-693

Form I-693, the Report of Immigration Medical Examination and Vaccination Record, is the document that proves you are not "inadmissible" to the United States on health-related grounds. If you are adjusting status inside the United States (most green card applications filed with Form I-485), a doctor called a USCIS-designated civil surgeon examines you, fills out Form I-693, and seals it in an envelope that you submit — unopened — with your green card application. If you are applying for an immigrant visa from abroad through a U.S. consulate instead, a State Department-approved panel physician does an equivalent exam using different paperwork (not Form I-693). This article covers the adjustment-of-status version.

Who does the exam, and where do you find them

You cannot use your regular family doctor unless that doctor happens to be specifically designated by USCIS as a civil surgeon. USCIS maintains an online locator tool ("Find a Doctor") on uscis.gov where you can search for a designated civil surgeon near you. Civil surgeons are not USCIS employees — they are private doctors who have applied for and received this designation — and they set their own fees for the exam, which are separate from any USCIS filing fee. Because those fees vary by provider and change over time, call the office directly to ask what they charge rather than relying on a number you find online.

What the exam actually covers

The civil surgeon's job is narrow: determine whether you have a condition that makes you inadmissible on health grounds under the Immigration and Nationality Act. The exam generally includes:

• A physical exam and health history, including a review of your general condition.
• Screening for communicable diseases of public health significance — this has historically included testing for active tuberculosis and, depending on age and other factors, syphilis and gonorrhea. (HIV was removed from this list years ago and is no longer part of the exam.)
• Review of your vaccination history against the vaccines the exam currently requires.
• Screening for physical or mental disorders associated with harmful behavior, and for substance use disorders, including a review of any history of a Class A or Class B substance-related finding.

Vaccinations

Applicants generally must show they have received (or are catching up on) a set of vaccines recommended by the CDC's Advisory Committee on Immunization Practices — historically this has included things like MMR, varicella, tetanus/diphtheria/pertussis, hepatitis A and B, polio, meningococcal, and influenza, depending on your age. This list, and which vaccines apply to which age groups, changes over time — for example, USCIS waived the COVID-19 vaccination requirement for adjustment-of-status applicants effective January 22, 2025, so it is no longer part of the exam for those applicants. Do not rely on any specific list you read online, including this one. The civil surgeon is required to apply the current CDC Technical Instructions, and you can check the current requirements yourself at the CDC's civil surgeon vaccination page and USCIS's "Vaccination Requirements" page before your appointment. If a required vaccine isn't medically appropriate for you (for example, because of pregnancy, allergy, or age), the civil surgeon can note that, and there are waiver processes — including a waiver based on religious or moral objection — for applicants who don't want a vaccine for reasons of conscience. Bring your existing vaccination records to the appointment; the civil surgeon may be able to accept titers (blood tests showing immunity) instead of a repeat shot for some vaccines.

Mental health and substance use screening

The civil surgeon must ask about, and note, any history of a physical or mental disorder connected to harmful behavior, and any history of a substance use disorder. If something concerning comes up, you may be referred to a mental health specialist for further evaluation; that specialist's report has to be attached to your I-693 and, if not originally in English, translated. This part of the exam is about identifying conditions tied to a current risk of harmful behavior — not about penalizing someone simply for having a mental health diagnosis or being in treatment.

The sealed envelope rule

After the exam, the civil surgeon signs and dates Form I-693 and seals it in an envelope, signing across the seal. Do not accept it, and do not submit it, if the envelope is not sealed. As a general rule you are not supposed to open it yourself, and if USCIS receives a paper envelope that looks opened or tampered with, they can reject it and require you to redo the exam. There is one important exception: if you file Form I-485 online, USCIS's current instructions direct you to open the sealed envelope and upload the completed Form I-693, then keep the original form and envelope until USCIS makes a final decision. Because the rules differ between paper and online filing, follow the current Form I-485 filing instructions and your civil surgeon's instructions exactly — the point is that the medical findings reach USCIS without being altered in between.

How long it's valid — and a real deadline to know

The validity rules for Form I-693 have changed more than once in recent years, so confirm the current rule at uscis.gov/i-693 before you rely on any timeline. Under USCIS policy guidance effective June 11, 2025, a Form I-693 signed by a civil surgeon on or after November 1, 2023, is valid only while the specific application it was submitted with is pending — if that application is withdrawn or denied, that I-693 is no longer valid, even if it's "still fresh," and you would need a new exam for a new filing. Separately, effective December 2, 2024, USCIS requires that Form I-693 (or at least the partial vaccination-record portion, where allowed) be submitted together with your Form I-485, or the I-485 may be rejected — so do not plan to file your green card application first and get the medical exam afterward. Check the current filing instructions for Form I-485 to confirm exactly what's required at filing, since these rules continue to change.

What to do

1. Confirm you actually need Form I-693. Some categories and some re-filings have exceptions; the civil surgeon or your attorney/accredited representative can tell you if one applies to you.
2. Find a USCIS-designated civil surgeon using the official locator tool on uscis.gov — not a random doctor or clinic that merely advertises "immigration physicals."
3. Gather your records before the appointment: a photo ID, your vaccination records if you have them, and any relevant medical history (especially anything related to tuberculosis, mental health treatment, or substance use).
4. Ask the office about current fees and what forms of payment they accept — civil surgeons set their own prices, and USCIS does not regulate what they charge.
5. Complete the exam and any follow-up testing (for example, a chest X-ray or additional lab work if the civil surgeon orders it) before the office finalizes your I-693.
6. Handle the completed form correctly. For a paper filing, receive the sealed envelope and keep it sealed; for an online filing, follow USCIS's current instructions for uploading the form. Store the original somewhere safe until you file.
7. File it with your green card application according to the current Form I-485 filing instructions, and check the current validity guidance so your exam doesn't become unusable due to a delay, a withdrawal, or a denial elsewhere in your case.

Costs and timing you should verify, not assume

This article intentionally does not quote a dollar figure for the civil surgeon's fee, because those fees are set by each individual provider and change constantly — call ahead. It also does not quote a processing time for how long it takes to get an appointment or how long USCIS takes to review your case, because those vary by location and change often. For current filing fees for the underlying application, check the USCIS fee schedule; for current vaccine requirements, check the CDC and USCIS pages linked above; and for anything about how a specific past finding on your I-693 might affect your case, talk to a qualified immigration attorney or a Department of Justice-accredited representative.

Beware of notario and "immigration consultant" fraud

Only a licensed attorney or a representative accredited by the Department of Justice can give you legal advice about your immigration case, including whether a medical finding might affect your eligibility. A "notario," immigration consultant, or unlicensed "visa service" that offers to interpret your medical results, promises a guaranteed outcome, or asks you to hand over original documents or sign blank forms is a red flag. If you need help finding low-cost or accredited legal help, search official government or nonprofit legal-aid directories rather than trusting an unlicensed preparer.

This article is general information, not legal advice, and reading it does not create an attorney-client relationship. Immigration medical and health-related inadmissibility issues can be complicated and consequential — consider consulting a licensed immigration attorney or a DOJ-accredited representative about your specific situation.