Visa Medical Examination: Tests, Vaccines, and Sealed Results

A visa medical examination is a required health screening performed by a government-designated doctor before U.S. Citizenship and Immigration Services (USCIS) or a U.S. consulate will approve a green card, K-1 fiancé visa, or most other immigrant visas. It exists because the Immigration and Nationality Act treats certain health conditions as grounds for denying admission to the United States.¹ The doctor screens for communicable diseases, checks your vaccination record, and evaluates mental health and substance use. Getting the right physician, the right documents, and the right handling of the sealed results is what separates a routine appointment from weeks of preventable delay.

Who Needs the Exam

Everyone applying for an immigrant visa or a green card needs one. That covers family-based petitions, employment-based cases, the diversity lottery, and any other immigrant category, whether you are filing Form I-485 to adjust status inside the United States or going through consular processing abroad. K-1 fiancé applicants also need the exam. Refugees and certain asylees complete the screening on a different timeline.

Which Doctor You Need

Your regular physician cannot do this exam unless they hold a specific government designation. Results from an unauthorized doctor are rejected, and you start over.²

If you are adjusting status inside the United States, you need a civil surgeon designated by USCIS. USCIS runs an online search tool where you enter a ZIP code to find one near you.³ Prices and availability vary widely, so call several before booking.

If you are applying at a U.S. Embassy or Consulate abroad, you need a panel physician appointed by the Department of State for that consular jurisdiction. Your embassy appointment letter typically lists approved panel physicians in the area.²

What to Bring to the Appointment

Showing up without the right paperwork is one of the most common reasons appointments get rescheduled. You need a valid government-issued photo ID such as a passport so the doctor can verify your identity.² If you are adjusting status, download Form I-693 from the USCIS website and fill in the biographical section (name, address, Alien Registration Number if you have one) before you arrive.⁴

Bring a full record of past vaccinations, hospitalizations, surgeries, and chronic conditions, plus a list of current medications with dosages. If you have been treated for psychiatric conditions or substance use, bring documentation of the diagnosis, treatment, and prognosis.²

Any record in a language other than English needs a full English translation. The translator must sign a certification stating the translation is complete and accurate and that they are competent to translate the language, including their printed name, signature, date, and contact information.⁴ A bilingual friend or relative can do this; a professional service is not required.

What the Exam Covers

This is not a general physical. It is a focused screening for conditions that affect immigration eligibility, with three parts.

Physical Examination

The doctor checks your eyes, ears, nose, throat, heart, lungs, abdomen, lymph nodes, skin, and extremities, looking for communicable diseases and conditions serious enough to interfere with your ability to care for yourself or work. Expect questions about cardiovascular, lung, musculoskeletal, and neuropsychiatric symptoms.⁵

Mental Health Screening

The mental status portion covers intelligence, thought processes, comprehension, judgment, mood, and behavior.⁵ The doctor will ask about psychiatric history, substance use, and any past behavior that harmed you or others.

Laboratory Tests

Which tests you get depend on your age:

Tuberculosis: everyone age 2 and older gets an Interferon-Gamma Release Assay (IGRA) blood test. A positive IGRA, HIV status, or TB symptoms trigger a chest X-ray. Children under 2 are not routinely tested.⁶
Syphilis: required for applicants ages 18 through 44. Outside that range, only if the doctor suspects infection.⁷
Gonorrhea: required for applicants ages 18 through 24. Outside that range, only if suspected.⁸

A positive test is not an automatic disqualifier. Treatment can resolve most of these infections, though it may delay your case while you complete it.

Vaccinations You Have to Prove

Vaccination is a separate ground of inadmissibility. Even if you are otherwise healthy, missing proof of required immunizations can block your case on its own. The CDC sets the list based on Advisory Committee on Immunization Practices (ACIP) recommendations, and not every routine U.S. vaccine is required for immigration purposes.⁹

The vaccines currently required are:

Measles, Mumps, and Rubella (MMR)
Polio
Tetanus, Diphtheria, and Pertussis (Tdap)
Haemophilus influenzae type b (Hib)
Hepatitis A
Hepatitis B
Rotavirus
Meningococcal disease
Varicella (chickenpox)
Pneumococcal disease
Influenza (seasonal, required October 1 through March 31)

Which specific doses you owe depends on age. The doctor compares your records to the age-appropriate schedule; if you cannot prove a required dose, they will administer it at the visit. Vaccination costs are typically charged separately from the exam fee.

Class A vs. Class B Findings

When the exam turns up an issue, the doctor puts it in one of two categories. The distinction is what determines whether your case moves forward.

A Class A finding makes you inadmissible and requires a waiver before approval. Class A conditions include a communicable disease of public health significance (active TB, infectious syphilis, gonorrhea, and others on the CDC list),¹⁰ failure to show proof of required vaccinations, a physical or mental disorder with associated harmful behavior that has caused injury or a serious safety threat or major property damage, and a substance use disorder involving a drug listed under the Controlled Substances Act.¹¹

A Class B finding is a serious or permanent condition that could affect your ability to work, attend school, or care for yourself, or that may require significant future treatment. It gets noted on the form but does not, by itself, block approval.¹¹

Marijuana and Substance Use Questions

This is where more applicants get hurt than they expect. Marijuana is still a Schedule I controlled substance under federal law regardless of state legalization. During the exam, the civil surgeon evaluates whether you have a substance use disorder using DSM-5 clinical criteria.¹²

For any substance listed under the Controlled Substances Act, including marijuana, a substance use disorder diagnosis is automatically a Class A condition. No additional finding of harmful behavior is needed. A single positive urine test or an admission of occasional use does not automatically trigger a diagnosis, but the doctor may ask pointed questions, and your answers can carry lasting immigration consequences.¹²

For non-controlled substances like alcohol, a substance use disorder is Class A only if the doctor also identifies associated harmful behavior, such as a DUI arrest or documented domestic violence. If you have a treatment history, bring records and prognosis documentation. Consistency between what you say and what your records show matters.

If You Cannot Get a Required Vaccine

There are two paths around the vaccination requirement, and they work very differently.

Blanket Waivers

The civil surgeon can grant a waiver directly on Form I-693 when a vaccine is not medically appropriate. No separate application is needed. This covers situations where the vaccine is not age-appropriate, where a medical contraindication such as a severe allergy or pregnancy makes it potentially dangerous, where the vaccine requires multiple doses and there is not enough time before your appointment to finish the series, where you are examined outside flu season (April through September) or the current season’s vaccine is unavailable, and where the CDC has declared a nationwide shortage with a corresponding USCIS notice.¹³

If a vaccine is deferred because of pregnancy or an immune condition, you will not be required to go back and get it after the condition resolves, as long as the contraindication was documented on the form at the time of the exam.¹³

Religious or Moral Conviction Waivers

If you object to all vaccinations based on sincere religious beliefs or moral convictions, you can apply for a waiver, and unlike most other inadmissibility waivers this one does not require a qualifying family relationship. The requirements are strict: you must oppose all vaccinations in any form (you cannot pick and choose), the objection must be rooted in religious belief or moral conviction rather than personal preference or safety concerns about a specific vaccine, and the belief must be sincere and consistently applied in your life. You do not have to belong to a particular religion or attend a specific house of worship.¹⁴

You submit a sworn statement explaining your beliefs and how compliance would violate them. Corroborating evidence, such as letters from community members, strengthens the application. Having previously received some vaccines does not automatically disqualify you, but the officer will weigh why you received them.

What It Costs

The government does not regulate what civil surgeons and panel physicians charge, so pricing varies. Base exam fees typically run from roughly $150 to over $700 depending on where you live and the provider. Vaccinations are almost always billed separately, and totals can range from nothing (if your records show full compliance) to $500 or more if you need several doses. Blood tests for TB, syphilis, and gonorrhea may carry separate lab fees. Call two or three clinics and ask for a full breakdown that includes the exam, labs, and per-vaccine pricing. Insurance rarely covers immigration medical exams.

The Sealed Envelope, and How Long Results Last

For adjustment applicants, the civil surgeon puts the completed Form I-693 and supporting documents in an envelope and seals it. Do not accept the form unless it is sealed.⁴ USCIS rejects any I-693 whose envelope has been opened, torn, or altered. If you break the seal, you repeat the entire exam and pay the fees again. Do not open it to check for errors. If you suspect a mistake, contact the civil surgeon’s office before touching the seal.

Submit the sealed envelope with your Form I-485 or bring it to your USCIS interview, following the instructions for your case.⁴ If you are consular processing, bring the sealed packet to your embassy interview.

USCIS changed the validity rules for any Form I-693 signed by a civil surgeon on or after November 1, 2023. The I-693 is now valid only while the application it was submitted with is pending. If that application is denied or withdrawn, the I-693 cannot be reused with a new filing.¹⁵ Getting the exam done well before filing carries less expiration risk than it used to, but more risk of wasted money if your case does not succeed, because those results will not carry over to a second attempt.

1
Office of the Law Revision Counsel. 8 USC 1182 – Inadmissible Aliens
2
U.S. Department of State. Medical Examinations FAQs
3
U.S. Citizenship and Immigration Services. Find a Civil Surgeon
4
U.S. Citizenship and Immigration Services. Instructions for Report of Immigration Medical Examination and Vaccination Record
5
Centers for Disease Control and Prevention. Medical History and Physical Examination
6
Centers for Disease Control and Prevention. Tuberculosis Technical Instructions for Civil Surgeons
7
Centers for Disease Control and Prevention. Syphilis Technical Instructions for Civil Surgeons
8
Centers for Disease Control and Prevention. Gonorrhea Technical Instructions for Civil Surgeons
9
Centers for Disease Control and Prevention. Vaccination Technical Instructions for Civil Surgeons
10
Centers for Disease Control and Prevention. Addendum to Technical Instructions: Communicable Diseases of Public Health Significance
11
U.S. Citizenship and Immigration Services. USCIS Policy Manual Volume 8 Part B Chapter 2 – Medical Examination and Vaccination Record
12
Centers for Disease Control and Prevention. Mental Health Evaluation for Civil Surgeons
13
U.S. Citizenship and Immigration Services. USCIS Policy Manual Volume 8 Part B Chapter 9 – Vaccination Requirement
14
U.S. Citizenship and Immigration Services. USCIS Policy Manual Volume 9 Part D Chapter 3 – Waiver of Immigrant Vaccination Requirement
15
U.S. Citizenship and Immigration Services. USCIS Changes Validity Period for Any Form I-693 Signed on or after Nov. 1, 2023