The immigration medical exam is a mandatory health screening that every Green Card applicant must complete with a USCIS-designated civil surgeon before USCIS approves permanent residency. Formally documented on Form I-693, this exam is not a general physical. It targets specific public health criteria set by the CDC and U.S. immigration law. The exam covers your medical history, a physical examination, required vaccinations, and laboratory tests. Understanding the immigration medical exam requirements before your appointment saves time, money, and avoids delays in your Green Card application.
1. What are the immigration medical exam requirements?
The immigration medical exam, officially called the Report of Medical Examination and Vaccination Record (Form I-693), screens applicants for conditions that could make them inadmissible under U.S. immigration law. Only a USCIS-designated civil surgeon can complete and sign this form. A regular licensed physician in the United States cannot perform this exam for immigration purposes. USCIS maintains a searchable database of authorized civil surgeons on its website.
The exam has four core components: a review of your medical history, a physical examination, a vaccination review, and laboratory testing. Each component checks for specific inadmissibility grounds, including communicable diseases, physical or mental disorders with harmful behavior, and drug abuse. Passing all four components is required before your civil surgeon signs Form I-693.
2. What vaccinations are required for the immigration medical exam?
The CDC vaccination schedule currently covers 15 diseases, effective march 11, 2025. The specific vaccines required for you depend on your age and the CDC Technical Instructions in effect at the time of your exam. Not every applicant receives every vaccine. Your civil surgeon reviews your records and determines which shots apply to your age group.
The COVID-19 vaccine is no longer required for the immigration medical exam as of january 2025. This is a significant update for applicants who delayed scheduling their exam due to concerns about that requirement. The current list of covered diseases includes measles, mumps, rubella, polio, tetanus, diphtheria, pertussis, Haemophilus influenzae type b, hepatitis A, hepatitis B, varicella, meningococcal disease, pneumococcal disease, rotavirus, and influenza.
Documentation standards are strict. Only written, original, and dated vaccination records from licensed medical personnel are accepted. Self-reported vaccination histories are rejected without exception. If you cannot produce original records for a required vaccine, the civil surgeon administers the missing shots at your appointment, which adds fees to your exam cost.
Waivers exist but are limited. Medical waivers apply when a vaccine is contraindicated due to a health condition. Religious waivers are available in narrow circumstances. Both require documentation and USCIS review.
Pro Tip: Gather your original childhood vaccination records before scheduling your exam. Tracking down records from overseas providers takes weeks, and missing vaccines administered at the civil surgeon's office add direct costs to your appointment.
3. What laboratory tests are performed during the exam?
The lab tests required during the immigration health exam vary by age group and are designed to detect communicable diseases of public health significance. Your civil surgeon orders the appropriate tests based on your age at the time of the exam.
- Tuberculosis (TB) screening: IGRA blood testing is required for all applicants aged 2 years and older. A positive IGRA result generally requires a follow-up chest X-ray to check for active TB infection.
- Syphilis blood test: Required for applicants 18 years and older. This screens for a communicable disease that carries public health significance under immigration law.
- Gonorrhea urine test: Standard for applicants ages 18 to 24. This test is not required for applicants outside that age range.
- HIV testing: Required for applicants 15 years and older. HIV is no longer a bar to admissibility, but the test remains part of the screening protocol.
- Chest X-ray: Ordered when TB screening is positive or when the civil surgeon finds clinical indications during the physical exam.
A positive result on any of these tests does not automatically disqualify your Green Card application. The civil surgeon documents findings on Form I-693, and USCIS reviews the results in the context of your full application.
4. How to prepare for your immigration medical exam appointment
Preparation is the single biggest factor in how smoothly your exam goes. Disorganized documentation is the most common cause of extra appointments and added costs.
- Bring valid government-issued photo ID. A passport or driver's license is required. The civil surgeon must verify your identity before the exam begins.
- Carry original vaccination records. Bring every vaccination record you have, including childhood immunization cards from your home country. Originals are required. Copies are not accepted.
- Gather relevant medical history documents. If you have a history of TB, mental health treatment, or substance abuse, bring documentation. The civil surgeon needs this to complete the medical history section accurately.
- Pre-fill Form I-693 where permitted. You can complete your personal information sections before the appointment. Do not sign the form until the civil surgeon instructs you to. Signing early invalidates the form.
- Schedule early and plan for multiple visits. The entire exam process takes 1.5 to 3 weeks, accounting for lab processing and any required follow-up visits. Plan accordingly and do not schedule your exam too close to an application deadline.
- Complete the process within 3 months. Your final appointment with the civil surgeon must occur within 3 months of your first visit. If that window passes, you must restart the entire exam. This rule adds real cost and time to your application if ignored.
Pro Tip: Schedule your immigration medical exam as early as possible in your Green Card process. Lab delays and follow-up appointments are common. Starting early gives you time to resolve issues without jeopardizing your application timeline.
For a full breakdown of the documentation required for your adjustment of status application, review the guidance from Hasan-legal on what USCIS expects at each stage.
5. How are exam results submitted with your Green Card application?
Form I-693 validity and submission rules changed in 2024. Form I-693 is valid for 2 years from the date the civil surgeon signs it, not from the date you file your application. This distinction matters if your Green Card case takes longer than expected to process.
The submission process differs depending on whether you file Form I-485 on paper or online.
| Filing Method | Envelope Handling | Form I-693 Submission |
|---|---|---|
| Paper filing | Keep envelope sealed | Submit sealed envelope with Form I-485 package |
| Online filing | Open sealed envelope | Upload Form I-693 digitally; retain original for USCIS requests |
Applicants filing Form I-485 online must open the sealed medical exam envelope to scan and upload Form I-693. They must then keep the original unsealed form in case USCIS requests it later. Paper filers submit the sealed envelope directly with their application package. Submitting the wrong version or breaking the seal on a paper filing causes processing delays.
USCIS will not accept a Form I-693 signed by anyone other than a designated civil surgeon. If your form is rejected for any procedural reason, you must return to the civil surgeon for corrections or a new exam.
Key takeaways
The immigration medical exam is a targeted public health screening completed by a USCIS-designated civil surgeon, documented on Form I-693, and required for every Green Card applicant.
| Point | Details |
|---|---|
| Civil surgeon is mandatory | Only a USCIS-designated civil surgeon can complete and sign Form I-693. |
| Vaccination records must be original | Self-reported histories are rejected; missing vaccines are given on-site at added cost. |
| COVID-19 vaccine no longer required | The vaccine was removed from the required list as of january 2025. |
| Plan for 1.5 to 3 weeks | Lab processing and follow-up visits make the exam a multi-appointment process. |
| Form I-693 is valid for 2 years | Validity runs from the civil surgeon's signature date, not your application filing date. |
What I've learned from guiding clients through the medical exam process
Most applicants come to me thinking the immigration medical exam is a full physical. It is not. The exam is a targeted screening for specific conditions that affect admissibility under U.S. immigration law. That distinction matters because it changes how you prepare.
The clients who run into problems are almost always the ones who underestimate the vaccination record requirement. Tracking down original records from a clinic in another country takes time. I have seen applicants delay their Green Card filing by weeks because they could not produce a childhood hepatitis B record. The fix is simple: start gathering those records the moment you decide to pursue a Green Card.
Timing is the other area where I see avoidable mistakes. The 3-month window between your first and final civil surgeon visit is a hard deadline. Missing it means restarting the exam and paying again. Schedule your exam early, treat each appointment as a firm commitment, and confirm your lab results are back before assuming the process is complete.
Choosing the right civil surgeon also matters more than most applicants realize. Not all designated surgeons have the same experience with complex cases, such as applicants with prior TB exposure or mental health history. A surgeon familiar with USCIS documentation standards will complete Form I-693 correctly the first time.
— Mahmudul
How Hasan-legal can help you prepare
Navigating the medical exam alongside a full Green Card application is a lot to manage on your own. Hasan-legal assists applicants with every step of the process, from organizing your vaccination records and medical documentation to reviewing Form I-693 before submission. Attorney Mahmudul Hasan, Esq. directly oversees each case, so nothing falls through the cracks.
Hasan-legal's team helps you understand exactly what USCIS expects, prepares your Form I-485 package correctly, and flags any documentation gaps before they become delays. Whether you are just starting your Green Card process or need help with a specific filing issue, you can explore the full range of immigration legal services available. Schedule a free case evaluation to get personalized guidance on your situation.
FAQ
What is an immigration medical exam?
The immigration medical exam is a mandatory health screening required for Green Card applicants. It is completed by a USCIS-designated civil surgeon and documented on Form I-693.
Who can perform the immigration medical exam?
Only a USCIS-designated civil surgeon can perform and sign Form I-693. A regular licensed U.S. physician does not qualify for this purpose.
Is the COVID-19 vaccine still required for the immigration medical exam?
No. The COVID-19 vaccine was removed from the required vaccination list as of january 2025. The current schedule covers 15 diseases under CDC Technical Instructions effective march 11, 2025.
How long is Form I-693 valid after the exam?
Form I-693 is valid for 2 years from the date the civil surgeon signs it. This validity period runs from the signature date, not from when you file your Green Card application.
What happens if I miss the 3-month window between civil surgeon visits?
If your final civil surgeon appointment does not occur within 3 months of your first visit, you must restart the entire immigration medical exam. This results in additional costs and delays to your application.
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