Immigration Medical Exam (Form I-693) 2026: Civil Surgeon, Vaccines, and What to Expect

Form I-693 (Report of Immigration Medical Examination and Vaccination Record) is the USCIS form used to document the results of the required immigration medical examination for most adjustment of status applicants. According to USCIS, nearly all I-485 (Adjustment of Status) applicants must submit a completed Form I-693 as part of their green card application — and getting it right is critical because errors or missing vaccinations can delay your case by months.

The I-693 is not a simple doctor’s note. It is a comprehensive medical and vaccination record conducted by a USCIS-designated civil surgeon following strict CDC Technical Instructions. This 2026 guide explains who needs it, how to find a civil surgeon, what the exam includes, vaccination requirements, how to handle the sealed envelope, and what happens if a medical condition is discovered.

Who Needs to Complete Form I-693?

The I-693 is required for most applicants filing Form I-485 (Application to Register Permanent Residence or Adjust Status). Specifically:

• Most I-485 applicants between ages 2 and older
• Children under 2 only need the vaccination record portion, not the full physical
• Some applicants are exempt from the vaccination requirement but still need the physical exam (this applies in limited circumstances like confirmed medical contraindication)

You do NOT need to file I-693 if you are:

• Applying for a non-immigrant visa extension or change of status (I-693 is only for green card applicants)
• A returning lawful permanent resident (re-entry after travel does not require a new medical exam unless you have been outside the US for 1+ year)
• Applying for naturalization (citizenship applicants do not need I-693)
• Applying for an immigrant visa at a US Embassy abroad (you get a separate panel physician exam at the embassy — not I-693)

Finding a USCIS Civil Surgeon

Only a USCIS-designated civil surgeon can complete Form I-693. Your personal physician, family doctor, or urgent care clinic cannot perform the immigration medical exam even if they are otherwise fully licensed. USCIS maintains a searchable database of civil surgeons at uscis.gov/civil-surgeons. You can search by ZIP code, city, or state.

Important tips for choosing a civil surgeon:

• Call ahead to confirm they are still active and accepting new patients — the USCIS database is not always up to date
• Ask about current pricing — costs range from $200 to $500 and are not covered by most health insurance plans
• Ask about wait times for appointments — some civil surgeons have waits of 2-4 weeks; schedule early
• Ask whether they have your vaccine records on file if you were previously their patient, or bring all prior vaccination documentation
• Confirm they are familiar with the current I-693 requirements and USCIS Technical Instructions update (significant changes were made effective November 2023)

What the Immigration Medical Exam Includes

The civil surgeon conducts a comprehensive evaluation divided into several components under CDC Technical Instructions for Civil Surgeons:

Physical Examination

A general physical exam covering:

• Height, weight, and vital signs
• Vision and hearing
• Cardiovascular and respiratory systems
• Abdominal examination
• Neurological screening
• Mental health screening (for substance abuse disorders and mental illness that may be relevant to inadmissibility)
• Physical findings that may indicate communicable diseases of public health significance

Tuberculosis (TB) Testing

TB testing is mandatory for all applicants 2 years and older. The civil surgeon may use either:

• Tuberculin Skin Test (TST/PPD), or
• Interferon-Gamma Release Assay (IGRA blood test — QuantiFERON or T-SPOT)

A positive TB test does not automatically bar you from getting a green card. If you test positive, the civil surgeon will order a chest X-ray. Latent TB (no symptoms, no active disease) is not a bar to adjustment — but active TB must be treated before the I-485 can be approved.

Sexually Transmitted Disease Screening

HIV testing is mandatory for all I-693 applicants ages 15 and older as of 2009 (HIV was removed from the inadmissibility list in 2010 — a positive HIV test no longer bars you from getting a green card). Gonorrhea syphilis screening is also required.

Vaccination Review and Administration

This is the most complex and often most costly part of the exam. The civil surgeon reviews your vaccination history and administers any missing vaccines. Required vaccines for I-693 in 2026 include:

If you have documentation of prior vaccinations, bring it to the appointment. The civil surgeon can use prior records; only missing vaccines need to be administered. Vaccines administered by the civil surgeon add cost — budget accordingly if you need multiple vaccines.

The Sealed Envelope: Critical Rules

After completing the exam, the civil surgeon completes Form I-693, signs and dates it, and seals it in an envelope with their signature across the seal. This sealed envelope must be submitted to USCIS unopened. USCIS will reject an I-693 that arrives in an unsealed envelope or shows evidence of having been opened.

Do not open the envelope. Do not ask the civil surgeon to open it so you can review it. If you have concerns about what was written, discuss them before the civil surgeon seals the envelope.

I-693 Validity Period

I-693 is valid for 2 years from the date the civil surgeon signs and dates it, provided the I-693 was submitted to USCIS within 60 days of the civil surgeon’s signature. If you submit the I-693 more than 60 days after the civil surgeon signed it, the validity period starts from the date USCIS receives it.

Practical implications:

• If you file your I-485 and include I-693 within 60 days of the civil surgeon’s signature: validity runs 2 years from the signature date
• If your I-485 case takes longer than 2 years and your I-693 expires: USCIS may request a new medical exam via an RFE
• If your interview is scheduled after your I-693 expires: bring a new I-693 to the interview

What Happens If a Medical Condition Is Found?

Most medical conditions do not bar you from getting a green card. The conditions that can create inadmissibility grounds are:

• Communicable diseases of public health significance: Active tuberculosis, active syphilis, gonorrhea, Hansen’s disease (leprosy). These must be treated before approval, but do not permanently bar you.
• Mental disorders with associated harmful behavior: A pattern of harmful behavior, not just a diagnosis, is required for a finding of inadmissibility.
• Drug abuse or addiction: Current substance use disorder may trigger inadmissibility requiring a waiver (Form I-601) or evidence of treatment.

If a potentially inadmissible condition is found, USCIS will give you an opportunity to provide additional medical documentation or apply for a waiver. Most conditions are treatable and do not ultimately prevent green card approval. For waiver options, see our I-601A Waiver guide (which covers unlawful presence waivers; health-related waivers use Form I-601).