Refugees Adjusting Status: The Vaccination-Only Form I-693

Refugees have their own rule for the immigration medical exam. Instead of the full exam most people adjusting status need, a refugee who was examined overseas before travel usually files only part of Form I-693. That rule is set out in the USCIS Policy Manual, in the regulation at 8 CFR 209.1 and on the Form I-693 page. This page covers who the rule fits, which parts of the form you file, who can complete them, and the cases where a full exam is still needed. Whether your own case fits is a question for your immigration attorney.

Why most refugees skip the full exam

If you were admitted to the United States as a refugee from abroad, a panel physician examined you for that admission. The regulation says a refugee adjusting status under section 209(a) does not have to repeat that exam, unless medical grounds of inadmissibility applied at the time of admission. The Policy Manual puts it in practical terms: you need an additional exam only if the panel physician’s exam revealed a Class A medical condition.

What the regulation does not waive is the vaccination requirement. Every refugee has to show compliance with it when adjusting, and the Policy Manual adds that the panel physician’s earlier vaccination assessment cannot be reused for the adjustment application. So the overseas exam covers the medical part, and a new vaccination record covers the rest.

The parts of Form I-693 you file

The Form I-693 page lists refugees who filed Form I-590 or Form I-730 and already completed a panel physician exam outside the United States among the applicants who submit a partial form. The instructions name the parts:

Parts 6, 8 and 9, the medical exam summary, worksheet and referral sections, are not part of the partial form. Since December 2, 2024, USCIS says you must submit Form I-693, or a partial Form I-693 such as the vaccination record, together with your Form I-485, or USCIS may reject the I-485. Plan the vaccination appointment before you file, not after.

Who can complete your vaccination record

You have two routes.

A health department. USCIS, in agreement with CDC, designated all state and local health departments as civil surgeons for one limited purpose: the vaccination assessment for refugees adjusting status. Taking part is voluntary for each health department, so not every one offers it. The instructions suggest contacting your state or local refugee health coordinator to find out whether a health department can complete Part 10. A health department working under this designation should look at your government-issued documents to confirm you are a refugee, so bring them.

A designated civil surgeon. Any physician USCIS has designated as a civil surgeon through the standard application process can complete the same parts. You can check a physician’s designation with the steps in our guide to what a civil surgeon is, and find a clinic near you if you want to book with one.

What a health department’s form must show

The Policy Manual lets nurses or other medical staff carry out the vaccination assessment and fill in the record, as long as a health department physician reviews and certifies the form. The instructions set out what Part 7 needs:

• The original or stamped signature of a physician on the health department’s staff. USCIS will reject a signature from a nurse, physician assistant or other professional who is not a licensed physician.
• The health department’s official stamp or raised seal, whichever it customarily uses.

The Policy Manual says that if a refugee’s form is signed only by a health department medical professional, without a physician’s signature, a Request for Evidence should be sent to the applicant for corrective action. Our guide to an I-693 Request for Evidence explains how those are answered.

When a refugee needs the full exam after all

The partial form is the usual case, not every case. The sources point to three situations where you should expect more:

• The overseas exam found a Class A condition. The Policy Manual and the instructions both say the full exam is repeated in that case.
• There is reason to believe a Class A condition was acquired after admission. The Form I-693 page says you may need a new exam then.
• You were granted refugee status as a family member while in the United States. The Policy Manual says family members granted refugee status in the United States must have a medical exam when they adjust.

A refugee who needs the entire exam goes to a physician designated as a civil surgeon through the standard process. The health department designation covers the vaccination component only. Our complete immigration medical exam guide walks through the full visit, and our vaccinations guide lists the vaccines the civil surgeon checks by age.

Getting the form sealed and filed

A vaccination-only form is still sealed like any other. The Policy Manual says the signed Form I-693 from a health department goes in a sealed envelope according to the form’s instructions, the same as every immigration medical exam. How you handle that envelope depends on whether you file Form I-485 by mail or online; our guide to an opened or damaged I-693 envelope covers both.

A short checklist

• Your refugee documents, so the health department or civil surgeon can confirm your status.
• Every vaccination record you have. The instructions say not to try to meet the vaccination requirements before the evaluation, in case a vaccine is not medically appropriate for you.
• Part 1 filled in, but not signed until you are asked to sign in front of the physician.
• Before you leave: Parts 5, 7 and 10 completed, Part 7 signed by a physician, and a stamp or seal if a health department did it.
• Your attorney’s answer on whether your case is the usual partial-form case, or one of the exceptions above.