The Immigration Medical Exam (Form I-693): The Complete 2026 Guide

The immigration medical exam is the health screening U.S. Citizenship and Immigration Services requires from most people applying for permanent residence from inside the United States. The results go on Form I-693, Report of Immigration Medical Examination and Vaccination Record, which a USCIS-designated civil surgeon completes, signs and seals. This guide covers what the exam involves, how to time it, what it costs, and the paperwork details that matter.

What changed recently

Check the current filing and medical instructions before scheduling. The rules below explain the relevant changes and link to official sources.

Sources: USCIS alert on filing with the I-485, USCIS policy update on validity, CDC syphilis instructions for civil surgeons.

What the exam is, and what it isn’t

The exam answers a narrow set of public-health questions for USCIS: whether you have a communicable disease of public health significance, whether your vaccinations meet CDC requirements for your age, and whether there is a physical or mental disorder with associated harmful behavior, or drug abuse or addiction. That is the whole scope.

It is not a general checkup. The civil surgeon is not your primary care doctor and is not there to judge you. Their job is to examine you according to CDC’s Technical Instructions and record what they find accurately.

It is also not a pass/fail test in the way people often imagine. Most chronic conditions, including diabetes, hypertension, asthma, thyroid disease and a treated mental health condition, have no bearing on admissibility. USCIS states that “neither harmful behavior nor a physical or mental disorder alone renders an applicant inadmissible.” Bring your records; an accurate form is far safer than an incomplete one. Our guide to health conditions and the green card medical exam goes into more detail.

Who needs the exam

In general, the exam is required for people applying to adjust status to lawful permanent residence on Form I-485, whether through family, employment, asylum or another category. Every family member who is applying needs their own exam and their own sealed form, including children.

Some groups are handled differently. For example, certain applicants who had a medical exam abroad before entering the United States may need only part of the form, and some categories have different timing. The rules depend on your specific case, so let your immigration attorney confirm what applies to you rather than assuming you are exempt.

Immigrant visa applicants abroad see a panel physician appointed by the U.S. Department of State instead.

Who can perform it

Only a physician USCIS has designated as a civil surgeon can perform the exam and sign Form I-693. A medical license alone is not enough, and a form signed by a doctor without the designation will not be accepted, however well qualified that doctor is.

You can check any doctor’s status using the official USCIS locator at my.uscis.gov/findadoctor. Search by ZIP code and confirm that the physician who will sign your form is listed. Our guide on what a civil surgeon is and how to verify one walks through the process and the warning signs to watch for.

When to schedule it relative to filing

Because most I-485 packages must now include the sealed I-693 at filing, work backward from your planned filing date:

1. Confirm your filing plan. If an attorney is preparing your case, ask when they want the medical in hand.
2. Book the exam early enough to cover lab turnaround. The form cannot be sealed until all results are back, and a positive TB screen adds a chest x-ray.
3. Leave margin for vaccines. If you are missing doses and choose not to get titers, some vaccines may need to be given before the form can be completed.
4. Do not go too far ahead of the rest of the package. A form signed on or after November 1, 2023 has no calendar expiration, but it attaches to the one application it is filed with. There is no advantage in getting it done a year before your case is ready.

For the full rules, including forms signed before November 2023 and what happens after a denial, see how long Form I-693 is valid.

What happens at the visit, step by step

Clinics vary in the order, but a typical immigration medical exam looks like this:

1. Check-in and identity. You show a government-issued photo ID, usually a passport. The clinic confirms your details match what will go on the form.
2. Medical history. The civil surgeon or staff ask about past illnesses, hospitalizations, medications, prior TB tests or treatment, and substance use. Answer accurately. A trustworthy clinic will never suggest what you should say.
3. Vaccination record review. The civil surgeon compares whatever records you bring, in any language, against the requirements for your age.
4. Physical exam. A general exam covering eyes, ears, nose and throat, heart, lungs, abdomen, lymph nodes, skin and extremities, and a brief neurological and mental status assessment. The skin check includes screening for Hansen’s disease.
5. Samples. Blood for the TB blood test (IGRA) and, by age, syphilis; urine for gonorrhea by age. Some clinics draw on-site; others send you to an outside lab.
6. Vaccines or titers, if needed. Any missing age-appropriate vaccines are given, or blood is drawn to check immunity instead.
7. Signing. You sign the form in front of the civil surgeon. Do not sign it beforehand.
8. Completion and sealing. Once all results are in, the civil surgeon completes and signs the form and seals it in an envelope for USCIS.

Our checklist of what to bring to the immigration medical exam covers documents in detail.

Required tests by age

The testing panel is set by CDC’s Technical Instructions for civil surgeons. It is shorter than most people expect.

Children under 2 do not get the TB blood test routinely; the civil surgeon evaluates them through history and physical exam, and tests further only if there are signs or symptoms of TB or known HIV infection.

Vaccinations

The vaccination section of the form requires age-appropriate protection against diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, rotavirus, Hib, hepatitis A, hepatitis B, meningococcal disease, varicella, pneumococcal disease and influenza. Not every vaccine applies to every person; what you need depends on your age and your records. Influenza applies only during flu season, which civil surgeons treat as September 1 through March 31. COVID-19 is no longer required.

If you have no records, blood tests called titers can show existing immunity to several of these diseases (measles, mumps, rubella, hepatitis A, hepatitis B, polio and varicella), which can save you from repeat doses. Our immigration medical exam vaccinations guide explains the list by age and how titers work. Primary source: CDC vaccination instructions for civil surgeons.

Results and TB

The result that causes the most worry is a positive TB blood test, and it is usually far less serious than people assume.

A positive IGRA means you have been exposed to TB bacteria at some point. It does not mean you are sick or contagious. The next step is a chest x-ray. If the x-ray is normal and you have no symptoms, CDC classifies the result as Class B2, latent TB infection, and CDC’s instructions state that treatment is not required to complete the form or the status adjustment. Treatment for latent TB is still worth discussing with a doctor for your own long-term health.

If the x-ray or symptoms suggest active disease, further testing is needed before the form can be finished. Our guide to a positive TB test on the immigration medical exam covers each scenario. Primary source: CDC tuberculosis instructions for civil surgeons.

The sealed envelope, and why the seal matters

When everything is complete, the civil surgeon places the signed Form I-693 in a sealed envelope. You carry or send that envelope to USCIS as part of your filing package, unopened. USCIS will not accept the form if the envelope has been opened or tampered with, so resist the urge to check the contents.

Ask the clinic for a separate copy of the completed form for your own records and for your attorney. That copy is how you confirm the details are right without breaking the seal. If you notice an error on the copy, go back to the clinic before you file.

Common reasons a form gets sent back

Many of the problems that lead USCIS to request a new or corrected I-693 are administrative rather than medical. Under the one-application rule, and with the form now required at filing, these mistakes cost more time than they used to.

None of these are hard to prevent with a careful review before sealing.

Cost, and what to ask before booking

Civil surgeons set their own fees, and advertised prices for the immigration medical exam vary widely. The headline number often leaves out lab work, the TB blood test, vaccines or a chest x-ray, and some clinics require a second visit to collect results. Health insurance generally does not cover the exam because it is required for an immigration benefit rather than for medical care.

Before you book, ask what the price includes line by line and what could be added. Our immigration medical exam cost guide has a full checklist of questions. Each clinic in our network publishes its price and what it includes and excludes on its clinic page.

Families and children

Each family member needs their own exam, form and sealed envelope. Scheduling everyone in one visit is usually easiest; ask whether the clinic can see several people at once.

Requirements change by age. A young child will not get the syphilis or gonorrhea tests and gets the TB blood test only from age 2, but may need more vaccines than an adult, such as rotavirus or Hib in infancy. Bring every child’s vaccination records, including school or pediatric records from any country. Ask whether the clinic prices children differently.

Working with an immigration attorney

If an attorney is handling your case, tell the clinic when you book. Attorneys usually care about three things: that the form is on the current edition, that it is complete and internally consistent, and that it is ready in time for the filing they are assembling. Share the attorney’s timeline, and ask whether the clinic can send a copy of the completed form to the attorney’s office. Attorneys and paralegals can find more on how we work with law firms at /for-attorneys/.

The civil surgeon records; your attorney advises on how anything in your history affects your case.

How to choose a civil surgeon

The USCIS locator tells you who is designated. It does not tell you who is available, what they charge, or how carefully they complete the form. Use this checklist:

• Designation confirmed. The physician who signs is listed at my.uscis.gov/findadoctor.
• Price published, with inclusions. You can see what the exam covers and what costs extra before you book.
• Lab handling explained. You know whether blood is drawn on-site or at an outside lab, and whether results require a second visit.
• Clear turnaround. The clinic tells you how long it typically takes to hand over the sealed form.
• Vaccine plan. They explain how they handle missing records, titers and vaccine pricing.
• Current rules. They do not mention a COVID-19 vaccine requirement or a two-year validity for new forms.
• Language access. Staff can communicate in a language you are comfortable with, or you can bring an interpreter.
• Attorney coordination. They will work with your attorney’s timeline if you have one.
• No coaching. They never suggest how to answer medical history questions.

Find a clinic

National Immigration Medical Exams is a network of independent, USCIS-designated civil surgeon practices. Every clinic page lists the civil surgeon by name with a link to verify the designation, the exam price, and exactly what is and is not included. Find a clinic near you, or browse our frequently asked questions.