Guide · Immigration

The Immigration Medical Exam and Form I-693: What It Covers and How to Prepare

A structured screening for specific grounds of inadmissibility, not a general checkup. Who performs it, what it covers, vaccinations, and waivers.

By Lincoln Square Law · 8-minute read

Almost every applicant for a green card must pass an immigration medical examination. For people adjusting status inside the United States, the exam is performed by a USCIS-designated civil surgeon and reported on Form I-693. For people processing abroad, it is performed by a panel physician designated by the State Department. The exam is not a general checkup. It is a structured screening for specific health-related grounds of inadmissibility, and small administrative mistakes, such as an unsealed envelope, a missing vaccine record, or a form signed at the wrong time, can delay a case for months. This guide explains what the exam covers, who performs it, how vaccination requirements and waivers work, and how to plan the timing.

Why the exam is required

The Immigration and Nationality Act makes four health-related conditions grounds of inadmissibility: a communicable disease of public health significance, failure to present documentation of required vaccinations, a physical or mental disorder with associated harmful behavior, and drug abuse or addiction (INA 212(a)(1)(A)). The regulations require every applicant for adjustment of status to be examined by a designated civil surgeon, whose report of the applicant’s physical and mental condition, including vaccination compliance, becomes part of the record (8 C.F.R. 245.5). The same regulation contains a narrow exception for certain applicants who entered as the fiancé(e) or spouse of a U.S. citizen and were examined abroad for that visa within the year before applying.

Who performs the exam

Only a designated physician may perform it. In the United States, USCIS designates civil surgeons, who must be licensed physicians with at least four years of professional experience, subject to limited exceptions (8 C.F.R. 232.2). Abroad, the State Department designates panel physicians. Both follow federal regulations and technical instructions issued by the Centers for Disease Control and Prevention (42 C.F.R. Part 34). An exam by any other doctor, however qualified, does not satisfy the requirement. USCIS maintains a locator for designated civil surgeons, and the designation should be confirmed before the appointment is booked.

What the exam covers

The federal regulations set the scope. Every exam includes a general physical examination, an evaluation for tuberculosis, and testing for syphilis, along with a review of vaccination records and an assessment for serious physical or mental conditions (42 C.F.R. 34.3). The listed communicable diseases of public health significance include active tuberculosis, infectious syphilis, gonorrhea, and infectious Hansen’s disease, as well as certain other diseases identified by executive order or international health rules (42 C.F.R. 34.2(b)).

Findings are classified. A Class A condition makes the applicant inadmissible unless a waiver is granted. A Class B condition is a physical or mental condition, disease, or disability serious in degree or permanent in nature that does not by itself bar admission but may bear on other questions, such as whether the applicant is likely to become a public charge (42 C.F.R. 34.2(d), (e)). Treatment of a condition found during the exam, such as tuberculosis, may need to be completed before the civil surgeon can sign the form.

The civil surgeon also asks about past and current use of drugs and alcohol and about mental health history, because those answers bear on the harmful-behavior and drug abuse grounds. The answers are recorded on the form and may be compared with arrest records, prior medical exams, and statements on other applications.

Vaccinations

The statute lists required vaccines, including mumps, measles, rubella, polio, tetanus and diphtheria toxoids, pertussis, Haemophilus influenzae type b, and hepatitis B, and adds any other vaccines recommended by the federal Advisory Committee on Immunization Practices (INA 212(a)(1)(A)(ii)). The CDC’s current list for adjustment applicants, last updated March 11, 2025, also includes rotavirus, hepatitis A, meningococcal, varicella, pneumococcal, and influenza vaccines, depending on age and circumstances. COVID-19 is not on that list.

Bring every vaccination record you have, including childhood records from abroad, with certified English translations. Documented doses avoid unnecessary repeat shots. Where records are missing, the civil surgeon may give the vaccines or, for some diseases, accept blood tests showing immunity.

The civil surgeon may also document that a vaccine is not medically appropriate. The CDC recognizes four reasons: the vaccine is not appropriate for the applicant’s age, it is contraindicated, there is insufficient time between doses, or it is influenza vaccine outside the season when it is available. When the surgeon records one of these reasons, the applicant does not need to file a separate waiver.

Waivers

The statute allows waivers for each health ground, on different terms (INA 212(g)). For missing vaccinations, the requirement may be waived for an applicant who receives the missing vaccines, for whom vaccination is certified as not medically appropriate, or who objects on the basis of religious beliefs or moral convictions under the conditions set by regulation (INA 212(g)(2)). The communicable disease ground may be waived for close family members of citizens and permanent residents and for certain self-petitioners (INA 212(g)(1)). The ground for physical or mental disorders with harmful behavior may be waived on terms and conditions the government sets, which can include a bond (INA 212(g)(3)).

Exams abroad

Applicants who complete their cases at a U.S. consulate are examined by a panel physician in their country, not by a civil surgeon. The panel physician follows the same federal regulations and technical instructions, and sends the results to the consulate rather than giving the applicant a form to file with USCIS. The consulate’s instructions set when to schedule the exam relative to the visa interview, and they often require the exam before the interview date. A Class A finding abroad leads to a waiver application filed with USCIS on Form I-601 after the consular officer finds the applicant inadmissible, which can add months to the case. An applicant with a known medical history should raise it with counsel before the interview is scheduled, not after.

Timing and the form

Form I-693 has its own rules about when it must be submitted and how long it stays valid, and USCIS has changed those rules several times since 2023. Before booking the exam, read the current instructions for Form I-485 and Form I-693 on the USCIS website and confirm whether the form must accompany the adjustment application and how long it will remain valid. Plan the appointment so that the form is complete, signed by the civil surgeon, and ready on the date it must be filed.

The civil surgeon gives the completed form in a sealed envelope, or submits it by the method the current instructions provide. Do not open the envelope. A form that arrives open or altered will not be accepted. Keep a copy of the completed form, which the civil surgeon can provide, and the receipt for any vaccines or tests.

Practical preparation

Before the appointment, gather the following:

• Identification. A government-issued photo ID, usually a passport.
• Vaccination records. All available records, with certified English translations of any in another language.
• Medical history. Records of any chronic condition, prior tuberculosis treatment, or mental health treatment relevant to the questions on the form.
• Medications. A list of current prescriptions.
• The form. The current edition of Form I-693, with the applicant’s section completed but not signed until the civil surgeon instructs.

Answer the civil surgeon’s questions honestly. Inconsistencies between the exam and other records, including prior medical exams for visas, can raise questions later.

When to get advice

Talk with counsel before the exam if there is a history of tuberculosis, a prior arrest or conviction involving drugs or alcohol, any mental health hospitalization, or an objection to vaccination. These are the situations where the exam can lead to a Class A finding or a waiver request, and where planning the order of steps protects the case.