Immigration Medical Exam Form I-693: Exam, Validity, and Cost

The Form I-693 immigration medical exam is the health screening you must complete with a USCIS-designated civil surgeon when you apply for a green card through adjustment of status inside the United States. The surgeon performs a physical, runs required lab tests and vaccinations, records the results on Form I-693, and seals the completed form in an envelope for you to submit to USCIS with your Form I-485.¹ Get it right the first time and you save weeks. Get it wrong and you pay for the whole exam again.

Nearly everyone filing Form I-485 needs a completed I-693. The exam checks for communicable diseases, verifies your vaccinations, evaluates whether you have a physical or mental disorder with associated harmful behavior, and screens for a substance-use disorder involving controlled substances.² Those findings feed directly into whether USCIS considers you inadmissible on health grounds.

Find a Civil Surgeon, Not Just Any Doctor

Your regular physician cannot complete Form I-693 unless they hold a specific federal designation. Federal regulations require the exam to be performed by a doctor selected as a civil surgeon by the USCIS district director for the area where you live.³ USCIS runs a “Find a Doctor” search tool on its website for locating civil surgeons near you.⁴ Use it. If you go to an unauthorized physician, USCIS will reject the entire form and you will need to pay for the exam again with a properly designated civil surgeon.

What to Bring to the Appointment

Walking in without the right paperwork is one of the most common reasons applicants end up scheduling a second visit. Bring:

A government-issued photo ID such as a current passport or valid driver’s license, so the surgeon can verify your identity before starting.
Vaccination records, including childhood immunizations if you can find them. Complete records reduce or eliminate the shots you need at the appointment.
The current edition of Form I-693, downloaded from uscis.gov with Part 1 filled out but not signed. Only the edition that is current on the date of your exam is accepted.⁵
Your Alien Registration Number if USCIS has assigned one, which goes in Part 1.
Prior medical records for anything relevant, especially a history of tuberculosis treatment, mental health treatment, or chronic illness. This helps the surgeon finish their assessment without ordering follow-up appointments.

You fill out Part 1 of the form yourself. Do not sign it in advance. You must sign Part 2 in the physical presence of the civil surgeon, and only when they instruct you to.⁶ A form signed too early can be treated as invalid.

What the Exam Covers

The visit usually runs one to two hours, though it can extend across multiple appointments if follow-up tests are needed. Beyond the general physical, the surgeon must complete the specific screenings the CDC requires.

Tuberculosis

TB screening is mandatory for all applicants age two and older. The current protocol uses an interferon-gamma release assay (IGRA), a blood test that has replaced the older skin test. Even with documentation of a previous positive skin test, you still need the IGRA drawn at this exam.⁷ A positive IGRA leads to a chest X-ray, and any abnormal result or symptom triggers a health department referral for further testing. A positive IGRA with a clean X-ray and no symptoms results in a Class B2 classification for latent TB infection, which does not make you inadmissible.

Syphilis and Gonorrhea

Syphilis testing is mandatory for applicants between 18 and 44 years old; outside that range it is only done when the surgeon suspects infection. The screen is a nontreponemal blood test such as the RPR.⁸ Gonorrhea screening is mandatory for applicants 18 to 24, using a nucleic acid amplification test on a urine sample or self-collected vaginal swab. The gonorrhea NAAT must be ordered by the civil surgeon at your exam; tests done elsewhere ahead of time are not accepted.⁹

Mental Health and Substance Use

The civil surgeon evaluates whether you have a physical or mental disorder with associated harmful behavior, using the DSM-5-TR.¹⁰ A diagnosis by itself does not make you inadmissible. What matters is whether the condition involves current harmful behavior, or past harmful behavior the surgeon judges likely to recur. Substance-use disorders involving controlled substances are evaluated separately under DSM criteria.

Vaccinations

Federal law requires adjustment applicants to show proof of vaccination against a specific list of diseases: measles, mumps, and rubella; polio; tetanus, diphtheria, and pertussis; rotavirus; Haemophilus influenzae type b; hepatitis A and hepatitis B; meningococcal disease; varicella; pneumococcal disease; and influenza.¹¹ Not every applicant needs every vaccine on the list. Requirements depend on your age, medical history, and what is age-appropriate under current CDC recommendations. If you bring complete immunization records, the surgeon can verify prior doses and skip what you already have. Without documentation, expect the surgeon to order antibody blood tests or simply re-administer the vaccine at the appointment, both of which raise the cost.

How Findings Are Classified

The civil surgeon sorts medical findings into two categories with very different consequences.

A Class A finding makes you inadmissible unless you obtain a waiver. The four Class A categories are: a communicable disease of public health significance (such as active TB, untreated syphilis, or untreated gonorrhea); failure to meet the vaccination requirements without a valid exemption; a physical or mental disorder with associated harmful behavior; and drug abuse or addiction involving a controlled substance listed under the Controlled Substances Act.²

A Class B finding means the surgeon identified a serious or permanent physical or mental condition that does not make you inadmissible. It is noted because it could affect your ability to work, study, or care for yourself, or may require significant treatment later. A Class B classification does not block your green card.

A Class A finding is not necessarily the end of your case. Federal law permits waivers of certain health-related grounds under specific circumstances, filed on Form I-601.¹² For communicable diseases and disorders with harmful behavior, a waiver is available if you are the spouse, unmarried child, or parent of a U.S. citizen, lawful permanent resident, or someone with an approved immigrant visa, and VAWA self-petitioners also qualify. The vaccination waiver is simpler: you can resolve it by getting the required vaccines, obtaining a certification that vaccination would be medically inappropriate, or showing that vaccination conflicts with your religious or moral convictions.

Sealing and Submitting the Form

Once the surgeon finishes the exam and signs Form I-693, they must place the completed original into a sealed envelope and hand it to you. Do not accept the form if the envelope is not sealed, and do not open it yourself. USCIS will reject the form if the seal is broken or the envelope looks altered.¹

You submit the sealed envelope to USCIS, not to the civil surgeon. The standard approach is to mail it with your Form I-485 to the filing location in the I-485 instructions.⁶ If your I-485 is already on file, you can submit the I-693 later in response to a Request for Evidence, or bring it to your green card interview. The envelope stays sealed until a USCIS officer opens it.

How Long the Form Is Valid

The validity rules changed on June 11, 2025, and the change is significant. Under the earlier policy in effect from April 2024 through June 10, 2025, USCIS treated any I-693 signed on or after November 1, 2023 as valid indefinitely. That policy has ended.

Under the current rules:

For forms signed on or after November 1, 2023, the I-693 is valid only while the specific immigration application you submitted it with (such as your Form I-485) is pending. If that application is denied or withdrawn, the form expires with it, and any future application requires a brand-new exam.¹³
For forms signed before November 1, 2023, the I-693 retains evidentiary value for two years from the civil surgeon’s signature date.⁵

Even when the form is technically valid, a USCIS officer who believes your medical condition has changed since the exam can request updated evidence or a new I-693 at their discretion. The practical takeaway: do not schedule the exam far ahead of filing your I-485, and if your case is denied and you refile, plan on paying for a second exam.

What the Exam Costs

USCIS does not regulate what civil surgeons charge, and prices vary widely by location and practice.⁴ When you call to schedule, ask for the total cost upfront and whether the quote includes vaccinations and lab work or only the exam itself. Vaccinations are usually the biggest variable. An applicant who arrives with complete immunization records often pays substantially less than one who needs several shots administered on the spot, and lab work for TB, syphilis, and gonorrhea adds to the total as well. Calling two or three civil surgeons in your area before booking is worth the time, because the same exam can cost noticeably more at one clinic than another a few miles away.

1
U.S. Citizenship and Immigration Services. I-693, Report of Immigration Medical Examination and Vaccination Record
2
U.S. Citizenship and Immigration Services. USCIS Policy Manual Volume 8 Part B Chapter 2 – Medical Examination and Vaccination Record
3
eCFR. 8 CFR 232.2 – Examination in the United States of Alien Applicants for Benefits Under the Immigration Laws and Other Aliens
4
U.S. Citizenship and Immigration Services. Finding a Medical Doctor
5
U.S. Citizenship and Immigration Services. USCIS Policy Manual Volume 8 Part B Chapter 4 – Review of Medical Examination Documentation
6
U.S. Citizenship and Immigration Services. Instructions for Report of Immigration Medical Examination and Vaccination Record
7
Centers for Disease Control and Prevention. Tuberculosis Technical Instructions for Civil Surgeons
8
Centers for Disease Control and Prevention. Syphilis Technical Instructions for Civil Surgeons
9
Centers for Disease Control and Prevention. Gonorrhea Technical Instructions for Civil Surgeons
10
Centers for Disease Control and Prevention. Mental Health Technical Instructions for Civil Surgeons
11
Centers for Disease Control and Prevention. Vaccination Technical Instructions for Civil Surgeons
12
Office of the Law Revision Counsel. 8 USC 1182 – Inadmissible Aliens
13
U.S. Citizenship and Immigration Services. Validity of Report of Immigration Medical Examination – Policy Alert PA-2025-08