Green Card Medical Exam: Cost, Vaccines, and What to Expect

The green card medical exam is a required immigration physical performed by a USCIS-designated civil surgeon (or, if you are applying from abroad, a State Department panel physician). It screens for certain communicable diseases, checks your vaccination history, and evaluates you for physical or mental conditions and substance use. The results are recorded on Form I-693 and submitted with your Form I-485 adjustment of status application.¹

Who Can Perform the Exam and What It Costs

Inside the United States, only a civil surgeon designated by USCIS can do the exam. You can find one through the USCIS “Find a Civil Surgeon” tool.² Applicants processing through a U.S. consulate abroad see a panel physician authorized by the Department of State instead.³

USCIS does not regulate what civil surgeons charge, so prices vary widely. The base exam fee at many offices runs several hundred dollars, and the total climbs once lab work and any needed vaccinations are added. Call around before booking. Many civil surgeons do not accept insurance, and those that do often will not cover the immigration-specific portions of the visit.³

What to Bring

Download Form I-693 from the USCIS website before your appointment. Fill in Part 1 with your name, address, and A-Number if you have one, and write your name and A-Number at the top of every page. Do not sign Part 2 yet; sign it in front of the civil surgeon. Leave every other section blank.⁴

Bring every vaccination record you can locate. The civil surgeon needs written documentation showing the month, day, and year each dose was given, entered by a physician or other medical professional.⁵ Records in another language need a complete certified English translation; partial translations and summaries are not accepted.

Also bring a government-issued photo ID such as a passport or driver’s license, a list of any medications you take, and records of prior treatment for conditions like tuberculosis or mental health disorders. Organized documentation reduces the chance the civil surgeon has to order additional tests.

What Happens During the Exam

Physical Examination

The civil surgeon checks major body systems, including heart, lungs, eyes, and skin, looking for signs of communicable disease or physical conditions with associated harmful behavior. It feels like a standard checkup, but the doctor is evaluating you specifically against the health-related grounds of inadmissibility.

Laboratory Tests

Age determines which lab tests are required. Syphilis blood testing is mandatory for applicants between 18 and 44; outside that range it is only done when there is reason to suspect infection. Gonorrhea screening follows a similar age-based rule.⁶ Both are on the federal list of communicable diseases of public health significance, so a positive result that has not been properly treated makes you inadmissible.⁷

Tuberculosis Screening

Every applicant two years or older takes an Interferon-Gamma Release Assay (IGRA), a blood test that measures your immune response to tuberculosis bacteria. The IGRA has replaced the older tuberculin skin test for nearly all applicants; the skin test is now only used for children under two when indicated.⁸ Even with documentation of a prior positive skin test, the civil surgeon must still run an IGRA. If the IGRA is positive, a chest X-ray follows to check for active disease. Only active, communicable tuberculosis (Class A) makes you inadmissible. Latent infection does not.⁹

Mental Health and Substance Use

The civil surgeon screens for physical or mental disorders with associated harmful behavior, applying diagnostic criteria from the American Psychiatric Association’s DSM-5-TR.¹⁰ A mental health condition only matters for immigration if it is currently causing harmful behavior or has a history of harmful behavior likely to recur. Otherwise it is noted as Class B, which is not a bar to admission.

Substance use disorders are evaluated separately, also under DSM criteria. Older standards that flagged experimental drug use or set rigid remission timeframes no longer apply. If you receive a current diagnosis, you can return to a civil surgeon later for a new evaluation to establish that the condition is in remission.¹¹

Vaccinations You Need

Federal law and CDC guidelines together set the required vaccines. The full list covers:¹²

Mumps, measles, and rubella
Polio
Tetanus and diphtheria
Pertussis
Haemophilus influenzae type B
Hepatitis A and Hepatitis B
Varicella
Influenza (seasonal)
Pneumococcal disease
Rotavirus
Meningococcal disease

Not every vaccine applies to every applicant. The civil surgeon checks each one against the CDC’s immunization schedule for your age group and only requires doses that are medically and age appropriate.⁵ COVID-19 vaccination is no longer required; that requirement was dropped as of January 20, 2025.¹³

If you are missing doses, the civil surgeon can often administer them during the appointment. Some vaccines are given in a series that takes weeks or months to finish. In that case, the doctor notes that insufficient time remained to complete the series, and USCIS grants a blanket waiver for that dose without a separate application.¹² Refusing an available, age-appropriate vaccine that is not medically contraindicated creates a Class A finding and makes you inadmissible.

When You Can Skip a Vaccine

Four blanket waivers let you skip a vaccine without filing a separate application. The civil surgeon marks the reason on Form I-693 and the officer grants the waiver during adjudication:

The vaccine is not age appropriate under the CDC schedule.
You have a medical contraindication, such as a condition that would make the vaccine likely to cause a life-threatening reaction. Pregnancy is an explicit example.
There is insufficient time to complete a vaccine series before the form must be submitted.
The influenza vaccine is only required during flu season when the current strain’s vaccine is available.

Religious or moral objections work differently. You cannot get a blanket waiver; you must file a separate waiver application with a fee. You do not need to file it proactively. If the officer sees a missing vaccine and no blanket waiver applies, they will ask why, either at your interview or through a written request for evidence, and guide you through the waiver process if you state a religious or moral reason.¹⁴ Refusing a vaccine for reasons unrelated to religion or moral conviction can result in an inadmissibility finding.

If You Are Pregnant

Pregnancy changes two parts of the exam. It counts as a medical contraindication for certain live vaccines, including measles, mumps, rubella, and varicella. The civil surgeon documents the contraindication on Form I-693 and USCIS grants a blanket waiver.¹²

For tuberculosis, a pregnant applicant who needs a chest X-ray after a positive IGRA can defer the X-ray until after delivery. The civil surgeon cannot submit a completed I-693 until the X-ray has been performed and interpreted, so USCIS will return an incomplete form for corrective action.⁹ Factor the delay into your timeline if you are pregnant or may become pregnant during the process.

The Sealed Envelope, Submission, and Validity

When the exam is complete, the civil surgeon seals the finished Form I-693 in an envelope and hands it to you. Do not accept it if it is not sealed, and do not open the envelope yourself. USCIS will reject the form and require a brand-new exam if the envelope arrives unsealed, opened, or tampered with.¹

Submit the sealed envelope with your Form I-485. USCIS now generally requires the medical results to accompany the I-485 rather than waiting for a request for evidence, which avoids delays from additional correspondence.¹⁵

A Form I-693 signed by the civil surgeon on or after November 1, 2023 stays valid the entire time the underlying immigration application is pending, with no fixed expiration date. It can only be used for the specific application it was submitted with.⁶ In practical terms, do not get the exam done far in advance of filing. If your I-485 is denied and you refile, you will likely need a fresh exam.

If the Exam Finds a Problem

Four categories of health conditions can block your green card:

Communicable diseases of public health significance, including active tuberculosis, infectious syphilis, infectious Hansen’s disease, and gonorrhea. Diseases that could trigger a public health emergency of international concern also qualify. A past infection that has been treated and resolved does not make you inadmissible.⁷
Missing required, age-appropriate vaccines with no applicable waiver.¹⁶
A current physical or mental disorder with associated harmful behavior, or a history of such behavior likely to recur.
A current drug abuse or addiction diagnosis involving any substance listed under the Controlled Substances Act.¹¹

A finding of inadmissibility does not always end your case. Waivers exist for communicable disease and for physical or mental disorders with harmful behavior if you have a qualifying U.S. citizen or lawful permanent resident spouse, parent, son, or daughter, or if you are a VAWA self-petitioner.¹⁶ Vaccination waivers work through the blanket and religious/moral routes described above. Drug abuse or addiction has no general waiver; you typically need a new medical evaluation establishing remission under current DSM criteria to move forward.¹¹ Waivers requiring a formal application are filed on Form I-601 with a general fee of $1,050, waived for certain applicants including VAWA self-petitioners and those with T or U nonimmigrant status.¹⁷

1
U.S. Citizenship and Immigration Services. I-693, Report of Immigration Medical Examination and Vaccination Record
2
U.S. Citizenship and Immigration Services. Designated Civil Surgeons
3
U.S. Citizenship and Immigration Services. Finding a Medical Doctor
4
U.S. Citizenship and Immigration Services. Instructions for Report of Immigration Medical Examination and Vaccination Record
5
Centers for Disease Control and Prevention. Vaccination Technical Instructions for Civil Surgeons
6
U.S. Citizenship and Immigration Services. Policy Manual Volume 8 Part B Chapter 4 – Review of Medical Examination Documentation
7
eCFR. 42 CFR 34.2
8
Centers for Disease Control and Prevention. Tuberculosis Technical Instructions for Civil Surgeons
9
U.S. Citizenship and Immigration Services. Policy Manual Volume 8 Part B Chapter 6 – Communicable Diseases of Public Health Significance
10
Centers for Disease Control and Prevention. Mental Health Technical Instructions for Civil Surgeons
11
U.S. Citizenship and Immigration Services. Policy Manual Volume 8 Part B Chapter 8 – Drug Abuse or Drug Addiction
12
U.S. Citizenship and Immigration Services. Policy Manual Volume 8 Part B Chapter 9 – Vaccination Requirement
13
U.S. Citizenship and Immigration Services. Vaccination Requirements
14
U.S. Citizenship and Immigration Services. Waiver of Immigrant Vaccination Requirement
15
U.S. Citizenship and Immigration Services. USCIS Now Requires Report of Immigration Medical Examination and Vaccination Record to be Submitted with Form I-485 for Certain Applicants
16
Office of the Law Revision Counsel. 8 USC 1182 – Inadmissible Aliens
17
U.S. Citizenship and Immigration Services. G-1055 Fee Schedule