I-693 RFE: What USCIS Asks For on the Medical Exam and How to Respond

A Request for Evidence is a notice about evidence, not a decision on the application. For Form I-693, the USCIS Policy Manual chapter on reviewing the medical exam tells the officer when to send one, and 8 CFR 103.2 sets the outer limit on how long a response may take. The Form I-693 page is where USCIS describes the separate step of rejecting a form. This page follows those three sources. It does not say how any one case will come out.

What the mailed notice contains

USCIS sends a request for evidence by regular or electronic mail. The notice has to name the type of evidence required, and it has to say whether that evidence is initial evidence or additional evidence, with enough detail to respond. It also states the deadline.

That deadline has a hard ceiling. In no case may the maximum response period on a request for evidence exceed twelve weeks, and additional time to respond may not be granted. USCIS gives up to 12 weeks to respond to a Request for Evidence, and the deadline can’t be extended. Twelve weeks is the longest period the regulation allows on the notice. A shorter date on the notice is the date that applies.

The same paragraph sets a different ceiling for a different notice. The maximum response time on a notice of intent to deny may not exceed thirty days, and extra time may not be granted for that notice either.

The last row summarizes the rejection cases on the Form I-693 page. That page does not give those cases a response period. They are set out below, and a rejection is not a request for evidence.

While USCIS waits for a response, its processing clock is paused when the request is for additional evidence rather than for missing initial evidence. For additional evidence, any time limit on USCIS processing is suspended as of the date of the request. It resumes at the same point when USCIS receives the response, or a request for a decision based on the evidence. If required initial evidence was missing, any processing time limit starts over from the date USCIS receives that evidence. None of these sources states how many days a request adds to a case.

The checklist officers use

The Policy Manual lists what every Form I-693 submitted to USCIS must meet:

• The form is completed legibly.
• All required parts are completed. A part the applicant did not need can stay blank. The manual’s example is a chest x-ray section when no chest x-ray was required.
• The civil surgeon who conducted the exam signed and dated the form.
• The applicant who was examined signed and dated the form. At age 14 or older, the applicant signs, and a legal guardian may sign for a person who is mentally incompetent. Under age 14, the applicant, a parent, or a legal guardian may sign, and the officer should not treat the form as improperly completed if only one of those people signed.
• Where a referral evaluation applies, the physician who completed it signed and dated the form.
• The form is still valid. How long a form stays tied to one application is a separate rule, covered in how long Form I-693 is valid.
• The form is in a sealed envelope, as the form instructions describe.

USCIS lists what every Form I-693 must include, such as all required parts completed, signatures from the civil surgeon and the applicant, and the current form edition. If a form doesn’t meet those requirements, USCIS generally issues a Request for Evidence to correct it. The manual is direct about the trigger: if those requirements are not met, or if the form or the envelope it was placed in has been tampered with, the officer should issue a Request for Evidence to correct the deficiencies. When possible, the officer should return the original form with that request and keep a copy.

The civil surgeon’s signature has to be an original. A stamp of the signature, another substitute, or a copy is not acceptable, except for the blanket-designated health departments and military physicians the manual describes. Only a physician USCIS has designated as a civil surgeon may conduct the exam in the United States and complete the form, and the physician must hold that designation when the exam is completed. A medical license alone is not enough. Our guide on what a civil surgeon is explains how to check a designation. The visit itself is covered in the immigration medical exam guide.

The edition date on the form

The Form I-693 page states the editions USCIS will take. If the civil surgeon signs on or before July 2, 2025, the form must be the 03/09/23 edition or the 01/20/25 edition. If the civil surgeon signs on July 3, 2025 or later, USCIS will accept only the 01/20/25 edition. The edition date sits at the bottom of the page. If any page is missing, or if the pages come from different editions, USCIS may reject the form.

The Policy Manual adds a timing rule that cuts the other way. In most cases the acceptable edition is the edition in use on the day the civil surgeon signs, because older editions may lack required information. Officers should not issue a Request for Evidence asking the applicant to meet a requirement that did not apply on that signature date, unless CDC says otherwise. The manual’s example is gonorrhea and syphilis testing: if the applicant had not reached the age range for those tests on the signature date, the officer must not require the tests later merely because the applicant has since reached that age. The same policy covers a later change in CDC’s instructions or a newer form edition, as long as the civil surgeon followed the instructions in effect on the signature date and used the edition that was current that day.

When the outcome is a rejection

A rejection is a different outcome from a Request for Evidence. These are the rejection cases taken from the Form I-693 page:

• An I-485 filed without the required I-693 may be rejected.
• A form with missing pages, or pages from a different form edition, may be rejected.
• USCIS says it will reject any unsigned form.

Effective December 2, 2024, USCIS requires Form I-693, or a partial Form I-693 such as the vaccination record, to be submitted with Form I-485. Otherwise USCIS may reject the I-485. The page lists who submits only the vaccination portion. Those categories are a different question from how to answer a request for evidence, and this page does not restate them.

The envelope is its own instruction. The civil surgeon must give you the completed Form I-693 in a sealed envelope. Do not accept it if it is not sealed. If you file Form I-485 by mail, submit that original sealed envelope with your application. If you file Form I-485 online, USCIS instructs you to open the sealed envelope and upload the completed Form I-693. Keep the original form and the envelope until USCIS makes a final decision. USCIS may review them at an interview or ask you to submit them. Ask the clinic for a separate copy for your records.

If the form or the envelope shows tampering, the Policy Manual tells the officer to issue a Request for Evidence, not to treat that as the rejection list above. There is one return path on the Form I-693 page: if USCIS rejects the application package and sends it back with the Form I-693 envelope opened, and you file again with that same opened form, you may include the original opened form and the civil surgeon’s supporting documents in the original envelope, with a copy of the rejection notice.

A missing vaccination is not on that rejection list. Compliance with the vaccination requirements, or a waiver, is one of the points an officer looks at when deciding whether the health-related burden of proof is met. If any of those points is not met, the officer follows standard procedures for a denial, a Request for Evidence, or a notice of intent to deny. Which vaccines apply at which ages is covered in the vaccination guide.

How the correction is completed

The Policy Manual describes an acceptable response as work a civil surgeon completes, in one of three ways. In each way the civil surgeon places the result in a sealed envelope, and the applicant delivers that envelope to USCIS.

1. The civil surgeon annotates the deficient parts of the original exam. The applicant and the civil surgeon both re-sign and re-date their certifications.
2. The civil surgeon completes an entirely new Form I-693 that corrects the original deficiency.
3. The civil surgeon completes a new Form I-693 limited to the applicant’s information, the part or parts that were deficient, and the civil surgeon’s information and certification. The original form and its documentation go in with those new parts. On a new form, the civil surgeon has to make sure the applicant has signed the applicant’s certification.

The manual does not say the second signature must come from the physician who signed the first form. It does say the response is completed by a civil surgeon.

Two situations are not corrected the same way. If an applicant refuses one part of the exam and the civil surgeon still certifies the form with a note that the exam is incomplete, the officer should issue a Request for Evidence for corrective action. If the civil surgeon records a Class A condition and the applicant refuses treatment, the officer should not send the form back to be fixed. The officer should determine that the applicant is inadmissible and ask the applicant to request a waiver, if a waiver is available. Whether a waiver is available in a given case is a question for an immigration attorney.

One tuberculosis finding should not produce this notice at all. If the applicant has latent tuberculosis infection, the officer should not issue a Request for Evidence for a health department referral. In that situation the civil surgeon reports to the health department and does not refer, and that report is not written on Form I-693. What a positive test means is covered in the guide to a positive TB test.

Sending everything in one response

Inside the period the notice gives, the regulation allows three choices: submit a complete response with all requested information at any time in that period; submit a partial response and ask for a decision based on the record; or withdraw the benefit request. All requested materials must be submitted together at one time, along with the original request for evidence or notice of intent to deny. Submission of only some of the requested evidence is considered a request for a decision on the record.

A benefit request shall be denied where evidence submitted in response to a request for evidence does not establish filing eligibility at the time the benefit request was filed. Failure to submit requested evidence which precludes a material line of inquiry is grounds for denying the benefit request.

USCIS can also decide not to ask. If required initial evidence was not submitted with the benefit request, or does not demonstrate eligibility, USCIS may deny the benefit request for lack of initial evidence or for ineligibility, or it may ask for the missing evidence within a period USCIS sets. For the Form I-693 completion list, the Policy Manual still tells the officer to issue a Request for Evidence. That instruction is not a promise that every incomplete filing receives one.

If the date passes with no reply

If a Request for Evidence isn’t answered by the deadline, USCIS may deny the application. The regulation states the same idea in three forms: the benefit request may be summarily denied as abandoned, denied based on the record, or denied for both reasons.

A denial due to abandonment may not be appealed. The applicant may file a motion to reopen. Withdrawal, or a denial for abandonment, does not preclude filing a new benefit request with a new fee. The priority or processing date of the withdrawn or abandoned request may not be applied to the later one. Choosing among a response, a motion, and a new filing is legal work for an immigration attorney, not a conclusion this page can draw from the notice alone.

Even a form that still meets the validity rule can be questioned. If an officer has reason to believe the applicant’s medical condition has changed since the civil surgeon signed, or that the form does not reflect the condition, the officer has discretion to request further evidence or a new or updated Form I-693. That discretion is not a second response clock written on this page. The notice, if one is sent, states its own deadline.

The rules above are the published ones, checked against the regulation, the Form I-693 page, and the Policy Manual chapter. A dated list of the same rules lives on our Form I-693 rules page. Nothing here predicts an approval, a denial, or how long a case will take beyond the response periods those sources state.