Form I-693 guide: immigration medical exam and vaccination record (Report of Immigration Medical Examination and Vaccination Record)

Wang Law Firm, LLC · David Wang, Managing Attorney · Attorney-reviewed · Updated October 2026

The official title of Form I-693 is Report of Immigration Medical Examination and Vaccination Record, and it is handled by U.S. Citizenship and Immigration Services (USCIS). People applying for a green card inside the United States (adjustment of status) must have a medical exam performed by a USCIS-designated civil surgeon; the civil surgeon records the results on the I-693 and seals it, and the applicant then submits it to USCIS. Its purpose is to show that the applicant is not inadmissible on any of the health-related grounds in section 212(a)(1) of the Immigration and Nationality Act (INA 212(a)(1)).

In the process, the I-693 is tied to the I-485. Since December 2, 2024, most I-485 applications must include the I-693 at filing, so the medical exam has changed from something "submitted later before the interview" into preparation that "must be completed before filing." People applying for immigrant visas through a U.S. embassy or consulate abroad do not use the I-693; they are examined by a panel physician designated by the Department of State. For general information about the exam (what it involves, what to bring, costs), see What to know about the immigration medical exam; this page focuses on the rules for the form.

At a glance

Who needs to file an I-693

• The vast majority of applicants filing an I-485 inside the United States, including principal applicants and derivative family members in family-based, employment-based and investment cases; children are no exception (the tests vary by age);
• Other situations where USCIS requires a medical exam, such as certain special programs for adjusting from temporary to permanent residence; follow the form instructions.

The following situations have their own rules, and you may need to submit only the vaccination record portion or may not need a full exam; check each against the I-485 and I-693 instructions:

• Applicants admitted as refugees who completed a medical exam abroad usually need only to supplement the vaccination record portion when adjusting status (unless the overseas exam found certain health conditions);
• Applicants who entered on a K-1/K-2 fiancé(e) visa or a V visa and were examined abroad by a panel physician generally do not need a new full exam if they adjust status within a certain period, but may need to supplement the vaccination record;
• Other special categories: follow the official instructions.

Applications for and extensions of ordinary nonimmigrant visas (such as B-1/B-2, F-1 and H-1B) do not use the I-693.

Legal basis: health-related grounds of inadmissibility

INA 212(a)(1)(A) sets out four health-related grounds of inadmissibility, and the medical exam is built around these four. The specific exam methods are set by the Centers for Disease Control and Prevention (CDC) in its Technical Instructions for Civil Surgeons:

1. Communicable diseases of public health significance: for example, active tuberculosis, syphilis and gonorrhea; the specific diseases are as currently specified by the CDC;
2. Failure to receive required vaccinations: age-appropriate vaccines recommended by the CDC's Advisory Committee on Immunization Practices (ACIP) are required;
3. Physical or mental disorders with associated harmful behavior;
4. Drug abuse or drug addiction.

Related procedural rules are found in provisions such as 8 CFR 245.5, and USCIS's review standards are in Volume 8, Part B of its Policy Manual (health-related grounds of inadmissibility). A problem found in the exam does not necessarily mean you cannot get a green card: many conditions can be treated and then certified by the doctor, and some can be waived.

You must use a USCIS-designated civil surgeon

• Only an I-693 completed by a USCIS-designated civil surgeon is accepted; an exam report from an ordinary family doctor cannot replace it;
• How to find one: use the official USCIS Find a Doctor tool and search by ZIP code;
• Before booking, confirm that the doctor is still on the designated list, ask whether the exam fee, lab fees and vaccine fees are charged separately, and how many days results usually take;
• Applicants serving in the military may be able to have the exam done by a qualifying military physician; follow the official instructions.

Completing the form (by main section)

Most of the I-693 is completed by the doctor and the applicant's part is small, but mistakes can still lead to rejection. Check specific item numbers against the current edition.

Information about the applicant

• Name, date of birth, A-Number (if any), address, etc. must match the I-485 and your passport;
• Use the current edition listed on the official page. USCIS introduced a new edition of the I-693 in 2025 (edition date 01/20/25) and stopped accepting older editions as of July 3, 2025 (except those signed by the civil surgeon on or before July 2, 2025). The edition date is printed at the bottom of each page; the edition is governed by the requirements in effect when the civil surgeon signs, and if a newer edition is released later, check the official page again before filing.

Applicant's statement and signature

• Do not sign in advance. The applicant must sign in front of the civil surgeon, who will check your identity documents;
• A parent or legal guardian may sign for a child under 14; follow the form instructions.

Interpreter and preparer

• If an interpreter is needed during the exam, the interpreter must complete the corresponding section.

Sections completed by the doctor

• Summary of exam results, tuberculosis screening, test results for syphilis, gonorrhea and others, physical and mental health assessment, and drug abuse assessment;
• Vaccination record: the doctor reviews the vaccination records you provide, administers any missing vaccines, or notes them as "not applicable" because of age, medical reasons, season, etc.;
• Referral record (if you need to be referred to a specialist or health department for further evaluation);
• The civil surgeon's certification and signature.

Before receiving the envelope, you can ask the doctor for a copy for your records and ask the doctor to confirm that nothing is missing from the applicant's section.

What to prepare before the exam

• Your passport or other government-issued photo ID;
• Complete vaccination records (for example, the Chinese childhood vaccination certificate), with an English translation, which can avoid unnecessary repeat vaccinations; for translation requirements, see Translation and notarization requirements;
• Significant past medical history and a list of medications you currently take;
• If you have had tuberculosis, an abnormal chest X-ray or related treatment, bring the relevant medical records;
• If you have any arrests or treatment related to alcohol or drugs, the doctor may ask about them; talk to your lawyer beforehand and answer truthfully;
• If the doctor asks, bring a blank copy of the current I-693 (many doctors have their own).

Recent changes to vaccine requirements

• The vaccine list follows the CDC's current Technical Instructions and changes with ACIP recommendations;
• COVID-19 vaccine: since January 22, 2025, the CDC no longer lists the COVID-19 vaccine as required for the immigration medical exam, and USCIS has said it will no longer issue RFEs or denials for a missing COVID-19 vaccination record;
• Those who decline vaccination on religious or moral grounds must apply separately for a waiver, which is reviewed strictly; consult a lawyer first.

Filing rules: must be filed together and kept sealed

Must be filed with the I-485 since December 2, 2024

Since December 2, 2024, USCIS has required most I-485 applications to include the I-693 at filing. Applications missing the I-693 may be rejected in full and must be refiled once complete. For applicants in categories with a waiting line, this could mean missing the window when the priority date is "current," so schedule the exam early in your filing plan.

Must be sealed

The doctor will give you the completed I-693 in a sealed envelope. USCIS will not accept it if the envelope has been opened, the seal is damaged or the form has been altered; you would have to ask the original doctor to reissue it or redo the exam. Simply place the sealed envelope in your application package as is.

Validity: the June 2025 policy

The I-693 validity rules have changed several times in recent years:

• The civil surgeon's signature date generally must be within 60 days before the application is filed;
• Under the USCIS policy updated in June 2025, an I-693 signed by the civil surgeon on or after November 1, 2023 is valid only for the application it was submitted with;
• This means that if an I-485 is withdrawn or denied, a new I-693 is usually needed when refiling an I-485;
• However, an application being rejected (not accepted for filing) is different from being denied: a returned I-693, even if the envelope was opened by USCIS, can generally be resubmitted with the corrected application together with the rejection notice; follow the official instructions;
• An I-693 signed before November 1, 2023 is subject to the validity rules in effect at that time;
• USCIS may still request a new or updated medical exam during adjudication, for example when a change in the applicant's age requires additional vaccines.

The validity rules may still change; before filing, follow the current guidance on the USCIS I-693 page and in the Policy Manual.

What happens after filing

1. The I-693 is accepted together with the I-485 and has no separate receipt;
2. The officer reviews the medical findings when adjudicating the I-485;
3. If the form is incomplete, the vaccination record has gaps or the edition is wrong, you may receive a request for evidence (RFE); for how to respond, see How to respond to an RFE;
4. If the exam finds a Class A health condition, you must be reevaluated after treatment or apply for a waiver; a Class B condition generally does not make you inadmissible but may require follow-up.

For I-485 processing times, see the USCIS processing times page.

Common problems that lead to rejection or RFEs

• The I-693 was not included when the I-485 was filed;
• The envelope was opened or the form was altered;
• An older edition that is no longer accepted was used;
• The applicant did not sign, or did not sign in front of the doctor;
• The doctor is not on the USCIS designated list;
• The vaccination record is incomplete, or lacks the doctor's explanation for "not applicable";
• The doctor's signature date is more than 60 days before filing;
• After a prior I-485 was denied or withdrawn, the previous I-693 was reused with the new filing.

Some health-related grounds of inadmissibility can be waived: for example, certain communicable diseases and mental disorders can be waived through the I-601; for missing vaccines, if vaccination is not medically appropriate, the doctor can note this on the form, while those who object to vaccination on religious or moral grounds must apply separately for a waiver. Drug abuse or addiction generally cannot be waived; the remission period set by the CDC must be reached. Whether a waiver is available and how to prove it are questions for a lawyer.

How the I-693 differs from related procedures

Frequently asked questions

Official sources

• USCIS: Form I-693 official page (form, instructions, accepted editions)
• USCIS Policy Manual, Volume 8, Part B: Health-Related Grounds of Inadmissibility
• USCIS: Find a civil surgeon
• CDC: Technical Instructions for Civil Surgeons
• USCIS: Form I-485 official page

Related reading

• What to know about the I-693 immigration medical exam
• Form I-485 adjustment of status guide
• Adjustment of status guide
• I-485 document checklist

This article is general information and is not legal advice. Laws and policies can change; rely on the latest official information and on an attorney's advice for your specific situation.