As part of the Green Card process, U.S. immigration law requires every applicant to undergo a medical examination to ensure they do not have any health conditions that would make them inadmissible on public health or safety grounds.
This exam is documented on Form I-693 (Report of Medical Examination and Vaccination Record).
This article explains exactly which documents you need, how to find a civil surgeon, and how to avoid the most common medical RFEs.
What Is Form I-693 and Why Is It Required?
Form I-693 is the official USCIS document that records the results of your medical exam.
It certifies that you are free from certain communicable diseases, have received all required vaccinations, and do not have a physical or mental disorder that poses a threat to others.
The exam must be completed by a USCIS-designated civil surgeon — not your regular family doctor (unless they are also on the approved list).
Critical: The medical exam report is valid for 2 years from the date the civil surgeon signs it. If your Green Card application takes longer than 2 years, you will need a new exam.
Documents You Must Bring to the Civil Surgeon
Before your appointment, gather these items. Failure to bring them will result in incomplete testing and additional fees.
- Government-issued photo ID: Passport, driver's license, or national ID card.
- Form I-693 (blank): You can download the latest edition from USCIS.gov, but most civil surgeons provide it. Check the edition date — expired forms are rejected.
- Vaccination records: Official, signed records from your home country or previous U.S. providers. Acceptable formats: yellow WHO vaccination card (Carte Jaune), school health records, or a signed letter from a doctor. If you have no records, you will need blood tests (titers) to prove immunity or receive new vaccinations.
- Medical history summary: Any chronic conditions (diabetes, hypertension, mental health diagnoses), surgeries, or hospitalizations. Bring a list of current medications.
- Tuberculosis (TB) test results: If you had a TB skin test (PPD) or blood test (IGRA) within the last year, bring the report. Otherwise, the civil surgeon will order one.
- Chest X-ray report (if applicable): If you have a history of positive TB or abnormal chest X-ray, bring the previous X-ray images and report. This can save you from repeating the test.
- Proof of any known inadmissible conditions: If you have HIV, untreated syphilis, or certain other conditions, bring treatment records. You may need a waiver (Form I-601).
- Payment: Fees vary widely ($150 to $500+). Call ahead to confirm. Insurance usually does NOT cover immigration exams.
What the Medical Exam Tests For
The civil surgeon will perform the following evaluations:
- Communicable diseases of public health significance: Tuberculosis (active and latent), syphilis, gonorrhea, Hansen's disease (leprosy). HIV was removed from the list in 2010 but is still reported.
- Vaccination compliance: You must show proof of immunity or receive the following vaccines (age-appropriate): MMR (measles, mumps, rubella), Varicella (chickenpox), Tdap/Td (tetanus, diphtheria, pertussis), Hepatitis A, Hepatitis B, Polio, Influenza (during flu season: October–March), Rotavirus (children only), Pneumococcal (adults 65+ or high risk), Hib (children).
- Mental or physical disorders with harmful behavior: The surgeon will assess if you have a history of violent behavior, substance abuse, or inability to care for yourself.
- Drug abuse or addiction: Positive urine drug screen for controlled substances (unless prescribed) can lead to inadmissibility.
Tip: Getting vaccinated before the exam can save you money. Many local health departments offer free or low-cost vaccines. The civil surgeon can also administer them but may charge $50–$150 per vaccine.
After the Exam: The Sealed Envelope Rule
Once the civil surgeon completes Form I-693, they will place it in a sealed envelope and sign across the seal.
You are NEVER to open this envelope. If you do, USCIS will reject it and you must return to the civil surgeon for a new seal (often with a new fee).
- Mail the sealed envelope together with your Form I-485 (or submit later if you forgot).
- If USCIS issues a Request for Evidence (RFE) for I-693, follow the instructions exactly — some RFEs ask you to bring the sealed envelope to the interview instead of mailing it.
- USCIS will not accept I-693 submitted more than 60 days before you file I-485. The signature date on I-693 must be no more than 60 days before USCIS receives your I-485. This is called the '60-day rule'.
Special Cases and Waivers
You may be found inadmissible based on medical grounds. Possible waivers (Form I-601) exist for:
- Vaccination non-compliance: Available for religious or moral objections (rarely granted).
- Communicable disease: If you are being treated and pose no public health threat.
- Mental/physical disorder: If you have documentation that you are in remission or under control with no harmful behavior.
Most applicants pass the medical exam without issues. The most common problem is missing vaccinations — easily resolved by a trip to a pharmacy or health clinic.
In summary, bring all your medical records to a designated civil surgeon, do not open the sealed envelope, and follow the 60-day rule.
A properly completed I-693 moves your Green Card application one giant step forward.