What Is Form I-693? Civil Surgeon Exam, Filing, and Validity

Form I-693, the Report of Immigration Medical Examination and Vaccination Record, is the sealed medical report that shows USCIS you are not medically inadmissible to the United States. A USCIS-designated civil surgeon completes it after examining you, and since December 2, 2024, most people applying for a Green Card must file the form I-693 immigration medical exam together with their Form I-485 adjustment of status application. Skip it, and USCIS can reject the whole package.¹

The exam screens for specific communicable diseases, reviews your vaccination history, and checks for physical or mental conditions associated with harmful behavior or drug abuse.²

Who Has to Submit Form I-693

Form I-693 is required if you are applying to adjust status to lawful permanent resident. Some applicants only need a partial form covering the vaccination record instead of the full medical exam. That partial form applies to refugees and derivative asylees who already had an overseas exam with a panel physician, K-visa fiancé(e)s and spouses of U.S. citizens who completed an overseas exam within one year of filing for adjustment, and Afghan nationals who arrived under Operation Allies Welcome with a prior overseas exam.³

If you are outside the United States, this form is not what you file. Overseas applicants see a State Department-authorized panel physician instead of a civil surgeon.⁴

Finding a Civil Surgeon

Only a USCIS-designated civil surgeon can complete Form I-693 inside the United States. USCIS runs a searchable directory on its website where you enter your ZIP code to find nearby designated physicians.⁵ Military physicians at military treatment facilities are automatically designated for veterans, active service members, and their dependents. State and local health departments are recognized as civil surgeons for refugee vaccination assessments.

Each civil surgeon sets their own fees. The physician’s portion of the exam typically runs from around $200 to $550, and that does not include lab work or vaccines you may still need. Most health insurance plans will not cover the exam itself, though some may reimburse separately billed items like blood tests, X-rays, or vaccines. Call a few offices before booking, and confirm coverage with your insurer.

How to Prepare

Fill out Part 1 of Form I-693 with your personal information before the visit, but do not sign or date it. You sign only in the civil surgeon’s presence.⁶ Bring the following:

A valid, unexpired government photo ID such as a passport or driver’s license. For an applicant under 14, bring a birth certificate (translated if needed) or an affidavit showing name, date and place of birth, and parents’ names.⁷
Any official vaccination records, including childhood immunizations received abroad.
Records of existing medical conditions, past treatments, or current medications.
Your health insurance card, in case parts of the appointment are separately billable.

Use the current edition of the form. The edition date appears at the bottom of every page. As of 2025, the current edition is dated 01/20/25, and if your civil surgeon signs on or after July 3, 2025, USCIS accepts only that edition. An older edition signed after that date will be rejected.³

What the Exam Covers

The civil surgeon’s evaluation has three parts: a physical and mental health assessment, a tuberculosis screening, and a vaccination review.

Physical and Mental Health Assessment

The civil surgeon reviews your medical history, takes vital signs, and conducts a physical examination. The assessment looks for communicable diseases of public health significance, physical or mental disorders with associated harmful behavior, and evidence of drug abuse or addiction. Required blood work includes a syphilis test. The civil surgeon also checks for gonorrhea and signs of infectious Hansen’s disease (leprosy).⁸

Tuberculosis Screening

All applicants age 2 and older must have an interferon-gamma release assay (IGRA), a blood test that detects immune reactivity to TB bacteria. A chest X-ray is required only if the IGRA is positive, if you have TB symptoms, or if you are HIV-positive. Children under 2 are screened through a physical assessment and medical history provided by a parent; lab tests come only if symptoms are present.⁹

If the screening suggests active TB, the civil surgeon refers you to the local health department for sputum testing. Only a Class A TB diagnosis (clinically active and communicable) makes you inadmissible. A positive IGRA on its own, without evidence of active disease, does not.⁸

Vaccination Review

The civil surgeon confirms you are up to date on the vaccines required for immigration purposes. If any are missing, the civil surgeon administers at least one dose of each age-appropriate vaccine you still need. Because some series take months, you are not expected to finish every series before filing, but you are expected to complete them on schedule afterward.¹⁰

Vaccinations are currently required for 15 diseases:¹¹

Mumps, measles, and rubella (MMR)
Polio
Tetanus, diphtheria, and pertussis (Tdap)
Haemophilus influenzae type B (Hib)
Hepatitis A
Hepatitis B
Varicella (chickenpox)
Influenza
Pneumococcal disease
Rotavirus
Meningococcal disease

The COVID-19 vaccine is no longer required. CDC removed it effective March 11, 2025, and USCIS stopped issuing denials or evidence requests based on COVID-19 vaccination status for any application pending on or after January 20, 2025.¹¹

If a vaccine is not medically appropriate for you because of an allergy, pregnancy, or similar reason, the civil surgeon notes that on the form and USCIS waives it. If you oppose all vaccinations on religious or moral grounds, you can seek a waiver using Form I-601, but the bar is high; more on that below.

Class A vs. Class B Findings

Any medical findings get classified into two categories, and the distinction matters for your case.

Class A conditions make you inadmissible. These include communicable diseases of public health significance (active TB, infectious syphilis, gonorrhea, and infectious Hansen’s disease), failure to meet vaccination requirements, physical or mental disorders with associated harmful behavior likely to recur, and drug abuse or addiction.¹² A Class A finding does not automatically end your case, but you will need a waiver or must resolve the condition before USCIS can approve your adjustment.

Class B conditions do not make you inadmissible. These are serious or permanent conditions the civil surgeon notes because they could affect your ability to work, attend school, or care for yourself, or may require significant future treatment. A Class B notation goes into your file but does not block your Green Card.

Filing the Sealed Form With Your I-485

When the exam is done, the civil surgeon places the completed Form I-693 into a sealed envelope. Do not accept the form if the envelope is unsealed, and do not open it yourself. USCIS will return the form if the envelope is unsealed or shows signs of tampering.³

Since December 2, 2024, Form I-693 (or the partial form, if you qualify) must be filed at the same time as Form I-485. USCIS made this change to reduce the volume of Requests for Evidence. Submitting an I-485 without the I-693 can get the entire package rejected.¹ For an I-485 that was already pending when the rule took effect, USCIS may still issue an RFE requesting the medical report.

There is no USCIS filing fee for Form I-693 itself.¹³ Your only costs are what the civil surgeon charges for the exam, labs, and vaccines.

How Long the Form Stays Valid

The old “two years from signature” rule no longer applies to most applicants. The current rules turn on the civil surgeon’s signature date:

Signed on or after November 1, 2023: the form is valid for the entire time your application remains pending. If that application is denied or withdrawn, any future application needs a brand-new Form I-693.¹⁴
Signed before November 1, 2023: the form is valid for two years from the signature date.

Even within these windows, a USCIS officer who believes your condition may have changed since the exam can request a new or updated Form I-693.

If the Envelope Opens or the Form Has Errors

An opened envelope or a mistake on the form does not necessarily waste your exam. USCIS will issue an RFE, and the civil surgeon can fix the problem in one of three ways: annotate and correct the deficient sections of the original form (with both you and the civil surgeon re-signing), complete an entirely new Form I-693, or complete only the deficient sections on a new form and include the original with it. In every case, the corrected form goes back into a new sealed envelope.¹⁴

One situation is different. If USCIS rejects your entire I-485 package (say, for a missing fee or unsigned form) and returns it with the I-693 envelope already opened by USCIS staff, you can refile that opened form with your new package as long as you include a copy of the rejection notice.

Waivers for a Class A Finding

A Class A finding does not necessarily end your case. You can apply for a waiver of health-related inadmissibility on Form I-601, submitting evidence explaining why you qualify and why USCIS should approve you despite the finding. Depending on your situation, that evidence might address a communicable disease, a vaccination exemption request, or a physical or mental disorder.¹⁵

The vaccination waiver comes up most often. If you oppose all vaccinations based on sincere religious belief or moral conviction, you file Form I-601 with a sworn statement explaining the nature and basis of your objection. USCIS evaluates three things: that you oppose every vaccination rather than selected ones, that the opposition is rooted in genuine religious or moral conviction rather than personal preference, and that the belief is sincerely held. Picking and choosing which vaccines to refuse will not qualify.¹⁶

1
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
2
Office of the Law Revision Counsel. 8 USC 1182 – Inadmissible Aliens
3
U.S. Citizenship and Immigration Services. Form I-693 – Report of Immigration Medical Examination and Vaccination Record
4
U.S. Citizenship and Immigration Services. Designated Civil Surgeons
5
U.S. Citizenship and Immigration Services. Find a Civil Surgeon
6
U.S. Citizenship and Immigration Services. Form I-693 – Report of Immigration Medical Examination and Vaccination Record
7
U.S. Citizenship and Immigration Services. Instructions for Report of Immigration Medical Examination and Vaccination Record
8
U.S. Citizenship and Immigration Services. USCIS Policy Manual – Communicable Diseases of Public Health Significance
9
Centers for Disease Control and Prevention. Tuberculosis – Technical Instructions for Civil Surgeons
10
Centers for Disease Control and Prevention. Vaccination – Technical Instructions for Civil Surgeons
11
U.S. Citizenship and Immigration Services. USCIS Policy Manual – Vaccination Requirement
12
U.S. Citizenship and Immigration Services. USCIS Policy Manual – Medical Examination and Vaccination Record
13
U.S. Citizenship and Immigration Services. G-1055, Fee Schedule
14
U.S. Citizenship and Immigration Services. USCIS Policy Manual – Review of Medical Examination Documentation
15
U.S. Citizenship and Immigration Services. Form I-601 – Application for Waiver of Grounds of Inadmissibility
16
U.S. Citizenship and Immigration Services. USCIS Policy Manual – Waiver of Immigrant Vaccination Requirement