What to know about the I-693 immigration medical exam
Whether you apply for a green card by adjusting status inside the U.S. or through an immigrant visa at an embassy or consulate abroad, you will almost always need an immigration medical exam. Its purpose is to confirm that the applicant has no health-related ground of inadmissibility under section 212(a)(1) of the Immigration and Nationality Act, such as certain communicable diseases of public health significance or failure to receive required vaccinations. The exam must be done by a designated doctor; a regular family doctor's exam report cannot be used instead.
1. Who needs an immigration medical exam
- Applicants filing an I-485 to adjust status inside the U.S.: the exam is done by a civil surgeon designated by USCIS, and the results are recorded on Form I-693 (Report of Medical Examination and Vaccination Record);
- Applicants for immigrant visas abroad: the exam is done by a panel physician designated by the U.S. Department of State, and the doctor submits the results as the embassy or consulate requires;
- Applicants for some nonimmigrant visas, such as the K fiancé(e) visa: also need an exam abroad by a panel physician;
- Refugees and other special categories have their own rules.
Ordinary nonimmigrant visas (such as B-1/B-2, F-1 and H-1B) usually don't require an immigration medical exam, unless the embassy or consulate requires otherwise.
2. You must use a designated doctor
| In the U.S.: civil surgeon | Abroad: panel physician | |
|---|---|---|
| Designated by | USCIS | U.S. Department of State (each embassy or consulate) |
| Used for | I-485 adjustment of status and other applications filed in the U.S. | Immigrant visas, K visas and other consular processing |
| How to find one | USCIS Find a Doctor | The designated clinics listed in the embassy or consulate interview notice or on the State Department website |
| How results are submitted | The doctor completes and seals the I-693, and the applicant submits it as USCIS requires | The doctor submits directly or gives the applicant a sealed envelope to carry, as the embassy or consulate requires |
Before booking, confirm the doctor is still on the designated list, and ask about the fee, whether it includes tests and vaccines, and how long results take.
3. What the exam covers
The specific components and testing methods are governed by the Centers for Disease Control and Prevention (CDC) Technical Instructions for Civil Surgeons and Technical Instructions for Panel Physicians. The exam generally includes:
- Medical history: past illnesses, hospitalizations and medications, as well as mental health and substance use; answer truthfully — concealment won't help you;
- Physical exam: including eyes, ears, nose and throat, heart and lungs, extremities, skin and lymph nodes;
- Tuberculosis (TB) screening: blood tests and the like depending on age and circumstances, with a chest X-ray and further testing if needed;
- Blood or urine tests for syphilis and gonorrhea: for the age ranges the CDC specifies;
- Mental health and substance abuse assessment: part of the exam;
- Review of vaccination records: see below.
A finding on a test doesn't necessarily mean you can't get a green card. Many conditions can be treated and the exam completed afterward, and waivers are available in some situations. Follow your doctor's and lawyer's advice.
4. Vaccination requirements
Immigrant applicants must receive age-appropriate vaccines under current CDC requirements. The specific list of vaccines changes with the CDC Technical Instructions and has changed in recent years, so rely on the CDC requirements in effect at the time of your exam. Practical tips:
- Bring your complete vaccination records to the exam (including vaccination booklets from your home country, such as China's vaccination certificate) with an English translation, to avoid unnecessary repeat shots;
- Missing vaccines can be given by the designated doctor, or may be deemed "not applicable" because of age, health reasons, flu season and the like;
- If you decline vaccination on religious or moral grounds, you must apply separately for a waiver, which is reviewed strictly.
5. Results are sealed — don't open them
For applications filed in the U.S., the civil surgeon will give you the completed I-693 in a sealed envelope (or may submit it in another way USCIS accepts). Do not open the envelope. USCIS will not accept an I-693 that has been opened or altered, and you would have to redo the exam. You can ask the doctor for a separate copy for your records.
6. When to submit, and validity
USCIS has changed its rules on when to submit the I-693 and how long it is valid several times in recent years: currently, most adjustment of status applicants must submit the I-693 together with the I-485; under the policy updated in 2025, an I-693 is generally valid only while the application it accompanies is pending, and if an I-485 is withdrawn or denied and then refiled, a new exam is usually required. For how long the exam is valid, when it must be submitted and what to do if it expires, check current USCIS policy — see the USCIS I-693 form page and the USCIS Policy Manual. For immigrant visas processed abroad, the validity of the exam results and the deadline to enter the U.S. are as stated by the embassy or consulate and on the visa.
Because the I-693 usually has to be submitted with the I-485, confirm your filing plan with your lawyer before scheduling the exam, so your filing isn't delayed because the medical report isn't ready. For the overall adjustment of status process, see Adjustment of status (I-485).
7. Cost
The applicant pays for the immigration medical exam. It is not included in USCIS or State Department filing fees and is usually not covered by health insurance (check your policy terms). Fees vary widely between doctors, and tests and vaccines may be billed separately, so ask before booking. To include the exam in your overall budget, see How to check immigration fees and processing times.
8. What to bring on exam day
- Your passport or other government-issued photo ID;
- For applications in the U.S.: a blank copy of the latest edition of Form I-693 (some doctors provide it), with the applicant section filled out as required — but don't sign it in advance; the applicant must sign in front of the doctor;
- For applications abroad: the embassy or consulate interview notice or appointment confirmation, and the photos the embassy or consulate requires;
- Vaccination records and their English translation;
- Significant past medical history, a list of medications for chronic conditions, and related medical records such as TB treatment or abnormal chest X-rays;
- If you have any arrests or alcohol- or drug-related records, the doctor may ask about them; talk with your lawyer beforehand and answer truthfully;
- A way to pay the exam fee (ask whether cards are accepted).
Children need exams too, and the tests vary by age. When the whole family is applying, you can book with the same designated doctor to make scheduling easier.
Common questions
Can my own family doctor do the exam?
No, unless they are also a USCIS-designated civil surgeon. Reports from non-designated doctors won't be accepted.
Do I need a chest X-ray if I'm pregnant?
The CDC Technical Instructions have specific provisions for pregnant applicants. Tell the doctor in advance that you are pregnant, and the doctor will handle it under the current instructions.
What if the exam finds TB or another condition?
You'll usually need further testing or treatment, after which the doctor issues a conclusion. Many situations can be resolved; keep all testing and treatment records and tell your lawyer.
What if the I-693 envelope has been opened?
An opened I-693 can't be used. Contact the original doctor to ask whether they can reissue a sealed report; otherwise you'll need a new exam.
Related reading
- Adjustment of status (I-485)
- Marriage-based green cards
- Translation and notarization requirements for immigration documents
Preparing to apply for a green card and want to confirm the timing of the medical exam and your filing? Book a consultation, and we'll plan a timeline based on your application category.
This article is general information and is not legal advice. Laws and policies may change; rely on the latest official information and on an attorney's advice for your specific situation.