Form I-693: Civil Surgeon Exam, Vaccinations, and Validity

To complete and submit Form I-693, you book an appointment with a USCIS-designated civil surgeon, fill in Part 1 yourself but wait to sign it in the doctor’s presence, let the civil surgeon conduct the exam, lab work, and vaccination review, and then mail the sealed envelope the doctor gives you together with your Form I-485. USCIS requires the two forms to be filed together, so schedule the medical exam before your green card application is ready to send.¹

Book a USCIS-Designated Civil Surgeon

Only a physician who holds a USCIS civil surgeon designation can perform the immigration medical exam and complete Form I-693. Your regular doctor, a specialist, or an urgent-care clinic cannot do it unless the provider carries that designation.² USCIS keeps a “Find a Civil Surgeon” search tool on its website; enter your zip code to see authorized doctors nearby.³

Civil surgeons set their own prices, and USCIS does not regulate what they charge.⁴ Expect to pay several hundred dollars for the exam, lab work, and any vaccinations you need, and call a few offices to compare. Most civil surgeons do not accept insurance, and even when they do, many insurers classify immigration exams as administrative rather than medically necessary. Individual vaccines or blood tests may be partially covered, so check with your insurer before the visit.

What to Bring, and What You Fill In

Show up with:

An unexpired government-issued photo ID such as a passport or driver’s license. The civil surgeon must verify your identity before starting the exam.⁵
A printed copy of the current edition of Form I-693, downloaded from the USCIS website. Using an outdated edition is a common reason USCIS returns the form.⁶
Written vaccination records showing the specific dates (month, day, and year) you received past immunizations. Records in a language other than English need a certified translation, with a signed statement from the translator certifying their competence and the accuracy of the translation.⁷⁸
Medical records from your treating physicians if you have a history of tuberculosis, a mental health condition, or substance use disorder. These conditions tie directly to the health-related grounds of inadmissibility, and the civil surgeon needs documentation to make a complete assessment.

You are responsible for completing Part 1 yourself. The civil surgeon handles every other section.⁵ Part 1 asks for your full legal name (last, first, middle) exactly as it appears on your immigration documents, your current physical address, your A-Number if you have one, your date of birth, city and country of birth, sex, and your USCIS Online Account Number if you have one from a prior filing.

Do not sign Part 1 before the appointment. You must sign the form in the civil surgeon’s presence, and signing at home can invalidate it.⁵

What the Exam Covers

The civil surgeon evaluates you against the health-related grounds of inadmissibility under the Immigration and Nationality Act,⁹ following technical instructions published by the CDC.³ The visit has three parts.

The physical exam is a general assessment of your overall health. The doctor checks for visible signs of communicable disease and evaluates whether you have a physical or mental condition that could pose a safety risk.

Lab work screens for communicable diseases of public health significance. The primary tests check for tuberculosis (usually a blood draw called an IGRA test), syphilis, gonorrhea, and HIV.¹⁰ Results typically take a few business days, so you won’t walk out with a completed form the same day. Plan to return or wait three to seven business days for the civil surgeon to finalize everything.

The vaccination review is usually the longest portion. The civil surgeon compares your immunization records against the required list and determines which shots you still need. A positive TB blood test does not automatically make you inadmissible; the doctor will order a chest X-ray, and if it is clear and you have no symptoms, the latent infection is noted on the form and you proceed normally. Abnormal results or symptoms trigger a referral for further evaluation before the doctor can clear you.

Required Vaccinations

Federal immigration law requires green card applicants to show proof of vaccination against specific diseases. The civil surgeon administers any missing vaccines during or after the exam for an additional cost. The required vaccines are:¹¹

Measles
Mumps
Rubella
Polio
Tetanus and diphtheria
Pertussis (whooping cough)
Haemophilus influenzae type B (Hib)
Hepatitis B
Varicella (chickenpox)
Influenza (required only during flu season, roughly fall through early spring)

Any vaccine recommended by the CDC’s Advisory Committee on Immunization Practices for the general U.S. population may also be required if it meets certain criteria.¹¹ The CDC publishes a detailed table matching required vaccines to age groups, which the civil surgeon follows.⁷ COVID-19 vaccination is not currently on the required list. Not every applicant needs every vaccine; age and documented immunity determine which ones apply.

If you have religious or moral objections, you may apply for a waiver by filing Form I-601 with the appropriate fee and evidence of your sincerely held beliefs.¹² Declining a vaccine without a qualifying objection can result in an inadmissibility finding.

Mail the Sealed Envelope with Your I-485

Once the exam and lab work are complete, the civil surgeon signs the form, seals it in an envelope, and hands it to you. Do not open that envelope. USCIS will return any Form I-693 that arrives unsealed, opened, or tampered with.⁵

Mail the sealed envelope together with your Form I-485. USCIS may reject your I-485 if the medical form is not included.¹ Send both forms to the filing location specified in the I-485 instructions.¹³ Because the two forms now travel together, schedule your medical exam early enough that the sealed envelope is in hand before your I-485 is ready to go out.

How Long Form I-693 Stays Valid

For any Form I-693 signed on or after November 1, 2023, the form remains valid for as long as the I-485 it was submitted with is pending. If that I-485 is withdrawn or denied, the form expires, and you need a new medical exam for any future application.⁶

For forms signed before November 1, 2023, the older two-year rule still applies: the form was valid for two years from the date the civil surgeon signed it.¹⁴ Even when a form is technically still valid, a USCIS officer who believes your medical condition may have changed since the exam can request a new or updated I-693.⁶

Common Reasons USCIS Rejects the Form

An incomplete or improperly prepared I-693 triggers a Request for Evidence, which stalls your case. The frequent problems:⁶

Wrong edition of the form. USCIS generally accepts only the edition that was current when the civil surgeon signed it, so downloading the form months in advance and using it later can create a mismatch.
Missing or invalid signatures. Both you and the civil surgeon must sign and date the form, and the doctor’s signature must be original. Stamps and photocopies are not accepted.
Unsealed or tampered envelope. If the envelope is open, torn, or shows signs of alteration, USCIS sends the form back.
Incomplete sections. Every required part must be filled out. If you refused part of the exam, the civil surgeon notes the refusal and USCIS will issue an RFE asking you to complete it.
Illegible handwriting throughout the form.

Before you leave the doctor’s office with the sealed envelope, confirm that the office used the current form edition and that both your signature and the doctor’s are on the document. Fixing these issues after USCIS flags them takes far longer than catching them at the counter.

If You Are Applying from Outside the United States

Form I-693 applies only to applicants adjusting status from within the United States. If you are processing your immigrant visa at a U.S. consulate abroad, your medical exam is performed by a panel physician authorized by the Department of State, not a civil surgeon.³ Panel physicians use a different form, the DS-7794 (or the older DS-2054), and submit results through the consular process rather than in a sealed envelope you carry yourself.⁶ If you previously completed an overseas exam as a refugee, derivative asylee, or K visa holder and are now adjusting status inside the U.S., you may only need the vaccination record portion of Form I-693 rather than a full new exam.

1
U.S. Citizenship and Immigration Services. USCIS Now Requires Report of Immigration Medical Examination and Vaccination Record to Be Submitted
2
U.S. Citizenship and Immigration Services. Instructions for Application for Civil Surgeon Designation
3
U.S. Citizenship and Immigration Services. Designated Civil Surgeons
4
U.S. Citizenship and Immigration Services. Finding a Medical Doctor
5
U.S. Citizenship and Immigration Services. USCIS Form I-693 Instructions
6
U.S. Citizenship and Immigration Services. Chapter 4 – Review of Medical Examination Documentation
7
Centers for Disease Control and Prevention. Vaccination Technical Instructions for Civil Surgeons
8
U.S. Department of State. Information About Translating Foreign Documents
9
Office of the Law Revision Counsel. 8 USC 1182 – Inadmissible Aliens
10
Centers for Disease Control and Prevention. Communicable Diseases of Public Health Significance
11
U.S. Citizenship and Immigration Services. Vaccination Requirements
12
U.S. Citizenship and Immigration Services. Waiver of Immigrant Vaccination Requirement
13
U.S. Citizenship and Immigration Services. I-693, Report of Immigration Medical Examination and Vaccination Record
14
U.S. Citizenship and Immigration Services. USCIS Announces New Guidance on Form I-693 Validity Period