Overview
Form I-693 (Report of Immigration Medical Examination and Vaccination Record) is the immigration medical exam report required of all applicants filing Form I-485 for Adjustment of Status to permanent residence. The exam must be performed by a USCIS-designated civil surgeon and includes a physical examination, blood tests (for tuberculosis, syphilis, etc.), vaccination record review, and a mental health assessment. Under the rule effective November 1, 2023, the validity of Form I-693 is tied to the I-485 application it accompanies — meaning the I-693 is valid only while the associated I-485 is pending. If the I-485 is withdrawn or denied, a new I-693 must be submitted with any future I-485 filing. As of December 2, 2024, Form I-693 must be submitted concurrently with Form I-485 (it can no longer be submitted separately after filing). As of January 20, 2025, the COVID-19 vaccine is no longer required for the immigration medical exam.
When You Need the I-693 Medical Exam
- Filing Form I-485 Adjustment of Status — I-693 must be submitted concurrently (all green card applicants)
- Immigrant visa applicants processed through a U.S. consulate abroad complete their medical exam at designated panel physicians (using a different form)
- K-1 fiancé(e) visa holders adjusting status in the U.S. require an I-693
- Refugees applying for I-485 one year after admission need an I-693
- Asylees filing for a green card require an I-693
- If a prior I-485 was denied or withdrawn, a new I-693 must be submitted with any subsequent I-485 (per November 2023 rule change)
Application Process
Find a Designated Civil Surgeon
Use the Civil Surgeon Locator tool on the USCIS website to find a designated civil surgeon near you by ZIP code. Only USCIS-designated civil surgeons are authorized to perform the I-693 examination.
Prepare for the Exam
Bring the following: valid identification (passport), Form I-693 (Part 1 pre-filled by the applicant), complete vaccination records (Chinese applicants should bring their immunization booklet/预防接种证), and any relevant medical records.
Physical Examination
The civil surgeon conducts a comprehensive physical exam, including: vision screening, height and weight measurements, blood pressure and vital signs, skin examination, heart and lung auscultation, abdominal examination, extremity and neurological checks, and a mental status assessment.
Blood Tests and Laboratory Work
Required tests include: TB blood test (IGRA, such as QuantiFERON Gold or T-SPOT) for applicants aged 2 and older; syphilis serology for applicants aged 15 and older; gonorrhea testing for applicants aged 18–24. If the TB test is positive, a chest X-ray is required.
Vaccination Review and Administration
The civil surgeon reviews vaccination records to ensure compliance with the ACIP-recommended immunization schedule. Any missing vaccines may be administered on the day of the exam. Required vaccines include: MMR (measles-mumps-rubella), Tdap, varicella, polio (IPV), hepatitis A, hepatitis B, influenza (seasonal), among others.
Completion and Sealing of Form I-693
The civil surgeon completes the medical portion of Form I-693 and signs it. The form is placed in a sealed envelope and given to the applicant. The applicant should not open the envelope and must submit it with their I-485 filing to USCIS.
Timeline Reference
| Stage | Duration |
|---|---|
| Schedule Appointment | 1–2 weeks (depending on availability) |
| Exam Day | 1–2 hours |
| Lab Results | 3–7 business days |
| I-693 Form Completion | 1–2 weeks after exam |
| I-693 Validity | Tied to associated I-485 application |
Frequently Asked Questions
How long is the I-693 valid?
Under the rule effective November 1, 2023, a Form I-693 signed by a civil surgeon on or after November 1, 2023, is valid only while the associated I-485 application is pending. If the I-485 is withdrawn or denied, the I-693 becomes invalid, and a new medical exam is required for any subsequent I-485 filing. Additionally, as of December 2, 2024, Form I-693 must be submitted concurrently with the I-485. Starting July 3, 2025, USCIS will accept only the 01/20/25 edition of Form I-693.
How much does the I-693 medical exam cost?
Costs vary by region and provider, typically ranging from $200 to $500. This generally covers the exam and basic blood work. Vaccinations, if needed, cost an additional $50–$200 per vaccine. Some insurance plans may cover vaccinations but not the exam fee itself. It is advisable to confirm pricing and accepted payment methods when scheduling your appointment.
Is the COVID-19 vaccine still required?
No. As of January 20, 2025, USCIS removed the COVID-19 vaccine from the list of required immunizations for the immigration medical exam. Applicants are no longer required to provide proof of COVID-19 vaccination, and civil surgeons will not require it during the examination. This change applies to all new and pending I-485 applications.
What happens if my TB test is positive?
If the TB blood test (IGRA) is positive, the civil surgeon will order a chest X-ray. If the X-ray shows no signs of active tuberculosis, you can generally proceed with completing the I-693. If the X-ray is abnormal, further sputum testing and treatment may be required. For Chinese applicants who received the BCG vaccine, the IGRA blood test is more accurate than the traditional tuberculin skin test (TST/PPD), as IGRA is not affected by prior BCG vaccination. Request that your civil surgeon use the IGRA test.
What should I bring to the medical exam?
You should bring: (1) a valid passport or government-issued ID; (2) Form I-693 with Part 1 pre-completed; (3) your vaccination record booklet (Chinese applicants: 预防接种证); (4) any prior medical records or X-rays (if you have a history of TB or related treatment); (5) a list of current prescription medications; and (6) glasses or contact lenses (if applicable). Having complete vaccination records can help avoid unnecessary revaccinations and additional costs.
How do I find a designated civil surgeon?
USCIS provides an online Civil Surgeon Locator tool (https://www.uscis.gov/tools/find-a-civil-surgeon) where you can search for designated civil surgeons by ZIP code. Only USCIS-designated civil surgeons are authorized to perform the immigration medical exam and sign Form I-693. Regular family physicians or emergency room doctors are not qualified. It is recommended to choose a doctor with extensive immigration medical exam experience to ensure the form is completed accurately.
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