🩺U.S. Immigration Medical Examination: I-693, Vaccines, TB Screening, and Civil Surgeons
USCIS immigration medical exam guide covering civil surgeons vs overseas panel physicians, Form I-693 procedures, CDC TB/vaccine protocols, sealed-envelope rules, and June 2025 validity update.
What is U.S. Immigration Medical Examination: I-693, Vaccines, TB Screening, and Civil Surgeons?
The U.S. immigration medical examination (Form I-693) is a mandatory admissibility requirement for most noncitizens adjusting status to lawful permanent residence (green card) inside the United States, administered exclusively by USCIS-designated civil surgeons rather than personal physicians or overseas panel physicians. Governed by CDC Technical Instructions, the evaluation encompasses a comprehensive physical and mental-status examination, age-specific vaccination assessments (accepting verifiable foreign immunization records and antibody titers), mandatory tuberculosis screening via an Interferon-Gamma Release Assay (IGRA) blood test for all applicants age 2 and older (with chest X-rays required only for positive IGRAs, HIV, or active symptoms), and targeted screening for communicable diseases like syphilis and gonorrhea (HIV is no longer an inadmissible condition). Crucially, under the landmark June 11, 2025 USCIS policy update, the obsolete two-year validity rule has been eliminated—an I-693 is now valid only for the duration of the pending underlying Form I-485 application—and must be submitted in an untampered sealed envelope, while out-of-pocket costs vary widely by civil surgeon and are rarely covered by standard health insurance.
Key Takeaways
Badge
Immigration Medical Exam
Costs
Do not publish a national $200–$500 civil-surgeon examination or $300–$800 total cost as though it were an official USCIS price. Civil surgeons are private medical providers and fees vary substantially.
- Civil-surgeon examination fee
- Laboratory tests
- IGRA
- Chest X-ray when required
- Vaccinations
- Follow-up visits
- Specialist consultations if required
- Medical records or translations in some circumstances
- City and state
- Civil surgeon's office
- Applicant's age
- Required laboratory tests
- Existing vaccination records
- Vaccines still needed
- Need for chest X-ray
- Need for additional medical evaluation
- Need for translations
Ordinary U.S. health insurance may not cover the immigration medical examination as a routine covered service. Ask both the provider and insurer before assuming any part will be reimbursed.
USCIS does not set one nationwide civil-surgeon fee. Applicants may compare several designated civil surgeons and ask for an itemized estimate before scheduling.
Meta Description
2026 guide to the U.S. immigration medical exam and Form I-693: civil surgeons, physical and mental examination, TB screening, vaccines, medical records, sealed-envelope rules, 2025 validity change, and what adjustment-of-status applicants should know.
Keywords
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What Form I693 Is
Report of Immigration Medical Examination and Vaccination Record
Form I-693 reports the results of the immigration medical examination and vaccination assessment to USCIS. The examination is used to determine whether the applicant has a health condition that could make the person inadmissible under the health-related grounds in the Immigration and Nationality Act.
Most applicants who are applying for adjustment of status to lawful permanent residence and who are required to undergo an immigration medical examination submit a Form I-693 completed by a USCIS-designated civil surgeon.
The examination is an immigration requirement, not an ordinary preventive physical for health insurance purposes.
CDC states that the civil surgeon is not responsible for deciding whether the applicant is eligible to adjust status. That determination is made by the DHS/USCIS officer after reviewing the complete immigration record.
Civil Surgeon Vs Panel Physician
The original title 'Pre-Entry Health Screening' should therefore not be used as though every immigration applicant has a U.S. civil-surgeon exam before entry.
When I693 Is Required
Many family-based adjustment applicants are required to submit the medical examination and vaccination record.
Employment-based adjustment applicants can also be required to submit Form I-693, depending on the circumstances of the adjustment application.
- Certain refugees adjusting status can have special vaccination-only rules.
- Certain K nonimmigrants may receive credit for a qualifying overseas medical examination when the applicable conditions are satisfied.
- Other special categories can have separate medical-exam instructions.
Follow the exact Form I-485 and USCIS instructions applicable to the person's immigration category rather than assuming that every green-card applicant follows an identical medical-exam procedure.
Year2025 Validity Change
Older USCIS materials described a two-year validity period for Form I-693.
USCIS changed the policy on June 11, 2025. A Form I-693 is generally valid only while the immigration benefit application or request with which the form was submitted remains pending.
USCIS states that an I-693 is no longer valid when the associated immigration benefit application or request is denied or withdrawn.
USCIS states that a new Form I-693 will generally be required with a subsequent immigration benefit application.
Do not tell applicants to calculate a simple two-year expiration date from the civil surgeon's signature. For current cases, the key question is the pending status of the immigration benefit application with which the form was submitted.
Filing Timing
USCIS revised Form I-485 filing requirements in December 2024 to require Form I-693 to be submitted together with the Form I-485 when required.
Even though the old two-year validity rule has changed, applicants should still schedule the medical exam early enough to complete laboratory testing, vaccinations, and any required follow-up.
Follow the current USCIS filing instructions for the I-485 edition being used and the applicant's immigration category.
Sealed Envelope
The civil surgeon gives the completed Form I-693 to the applicant in a sealed envelope for submission to USCIS.
The applicant should not open or alter the sealed envelope. USCIS instructions state that the agency will not accept Form I-693 if the envelope has been opened or altered.
The civil surgeon should also provide the applicant a copy of the completed Form I-693 for personal records.
The applicant submits the sealed envelope to USCIS according to the applicable filing instructions.
Documents that do not need to be included in the sealed envelope should be returned to the applicant.
Medical Examination Components
Infectious Disease Screening
Tuberculosis
Under the current CDC Technical Instructions for civil surgeons, all applicants age 2 or older must have an interferon-gamma release assay (IGRA).
The previous wording 'IGRA blood test or TST for everyone age 2+' is incorrect. The current civil-surgeon instructions require IGRA for applicants age 2 or older; TST is reserved for certain children under age 2.
Vaccination Requirements
The civil surgeon reviews the applicant's age, vaccination history, documented immunity, and medical contraindications to determine which age-appropriate vaccines are required.
The list above is the set of diseases covered by the vaccination technical instructions, not a statement that every applicant must receive every vaccine on the list.
CDC's Table 1 determines which vaccines are required for each applicant according to age. For example, some childhood vaccines are not required for adults.
Applicants do not necessarily need to complete every multi-dose vaccine series before filing. The civil surgeon generally administers at least the age-appropriate dose required at the exam when the applicant is not up to date, and the remaining series can be completed according to the applicable schedule.
Covid Vaccination
Do not publish COVID-19 vaccination as a simple universal vaccine requirement without checking the current CDC vaccination technical instructions and the applicant's circumstances. CDC's vaccination requirements are based on its current technical instructions and age-appropriate requirements.
The immigration vaccination list is not identical to the general adult ACIP vaccination schedule.
Syphilis And Gonorrhea
CDC technical instructions contain specific age-based and risk-based requirements for syphilis screening.
CDC technical instructions contain specific applicant-age criteria for gonorrhea testing.
Do not tell every applicant that both tests are automatically performed in exactly the same manner. The current CDC technical instructions determine which applicants require which tests.
Mental Health And Substance Use
The examination includes a mental-status evaluation. Immigration law focuses on specified health-related grounds, rather than treating every mental-health diagnosis as an automatic inadmissibility finding.
A history or diagnosis involving substance use is evaluated under the specific immigration medical criteria. A past history alone should not be described as an automatic bar.
Applicants with significant psychiatric or substance-related treatment history should bring relevant medical records when available and disclose information accurately.
Medical Conditions
Having a chronic disease, disability, cancer history, diabetes, hypertension, or another medical condition does not automatically make an applicant inadmissible.
The immigration medical examination focuses on specified health-related grounds of inadmissibility, including certain communicable diseases of public health significance.
The civil surgeon records the medical findings required by the technical instructions; USCIS makes the final immigration decision.
What To Bring
- Valid passport or other acceptable government-issued photo identification
- Immigration documents requested by the civil surgeon
- USCIS notices or filing information when relevant
- Address and contact information
- Official vaccination record
- Physician or clinic records
- Childhood immunization records
- Laboratory immunity results when available
- Reliable foreign vaccination records with English translation if needed
- Current medication list
- Relevant medical records
- Chronic-disease documentation
- Prior TB records
- Prior chest X-rays when relevant
- Psychiatric treatment records when relevant
- Specialist reports when relevant
- Form I-693 or instructions from the civil surgeon
- Form I-485 information where applicable
- Payment method
- Previous USCIS correspondence relating to the medical examination
Foreign Vaccination Records
Vaccines received outside the United States are not automatically disregarded. CDC states that reliable foreign vaccination records can generally be accepted when they satisfy documentation requirements.
- Exact vaccination date
- Month/day/year when available
- Vaccine or disease identified
- Record appears authentic and unaltered
Records not in English should be accompanied by a reliable English translation. The applicant is responsible for providing the translation.
Where permitted by CDC instructions, laboratory evidence of immunity can avoid unnecessary vaccination.
Children
Children have age-specific vaccination and TB-screening requirements. The civil surgeon applies the CDC table appropriate to the child's age.
Children younger than 2 do not automatically receive the same IGRA requirement as applicants age 2 and older.
Rotavirus is an example of an age-limited vaccination requirement; it is not an adult vaccination requirement.
Hib is another example of a vaccine that is generally age-specific rather than universally required for adults.
Older Adults
Older adults can have a substantially different vaccination assessment because requirements are age-specific.
Pneumococcal vaccination requirements under the immigration medical exam depend on the CDC age-based table.
Seasonal influenza is one of the vaccines included in the civil-surgeon technical instructions and is assessed according to the current applicable seasonal and age requirements.
Finding Civil Surgeon
USCIS provides a Find a Doctor search for designated civil surgeons.
- Use the official USCIS civil-surgeon locator.
- Confirm the physician's current designation.
- Call the office before scheduling.
- Ask which I-693 edition the office currently accepts/prepares.
- Ask what identification and vaccination records are required.
- Ask for a complete fee schedule before the appointment.
Do not rely on a directory listing without checking the doctor's current status and appointment availability.
Appointment Preparation
After The Exam
Keep the USCIS envelope sealed until it is submitted according to USCIS instructions.
Retain the copy provided by the civil surgeon for future reference.
If USCIS later requests evidence or correction, follow the notice and coordinate with the civil surgeon when the deficiency concerns the medical examination.
If an immigration benefit application is later denied, withdrawn, or a new benefit application is filed, review the current I-693 validity rule rather than assuming the old form remains valid indefinitely.
Special Cases
Refugees adjusting status can have special I-693 vaccination-assessment rules depending on the overseas exam and the medical findings.
Asylees adjusting status can have specific vaccination and civil-surgeon requirements. Do not automatically apply refugee-specific blanket civil-surgeon rules to asylees.
Certain K nonimmigrants who already completed a qualifying overseas medical exam can avoid repeating the full examination when the regulatory and filing conditions are met.
USCIS has special provisions for certain U.S. armed-forces applicants and dependents, including specific blanket-designated physicians.
Medical Exam Vs Health Insurance
Determines whether the applicant satisfies specified immigration medical requirements.
Pays covered healthcare expenses under an insurance contract.
Passing an immigration medical examination does not establish health-insurance eligibility, and health insurance does not replace the immigration medical examination.
Vaccines, laboratory tests, X-rays, and the civil-surgeon fee may have different insurance treatment. Confirm before assuming the applicant's existing plan will pay.
Applicant Checklist
Confirm whether the case requires a civil surgeon or overseas panel physician.
Use the official USCIS civil-surgeon locator when a U.S. exam is required.
Bring passport or accepted photo identification.
Bring all written vaccination records.
Bring reliable English translations for foreign-language medical/vaccine records.
Bring laboratory immunity results when available.
Bring relevant medical and TB records.
Bring current medication information.
Ask for the complete examination and laboratory fee before scheduling.
Complete required vaccinations/testing/follow-up.
Verify that the civil surgeon gives you a sealed I-693 envelope and personal copy.
Do not open or alter the sealed envelope.
Questions For Civil Surgeon
Are you currently designated by USCIS as a civil surgeon?
Which Form I-693 edition are you currently using?
What documents should I bring?
Which vaccination records are acceptable?
Do foreign-language records need certified or other reliable English translation?
Which laboratory tests are included in your quoted examination fee?
Is the IGRA included?
What is the additional charge for a chest X-ray if required?
How are vaccines billed?
What happens if I need additional testing or specialist evaluation?
When will the I-693 be completed?
Will I receive a personal copy?
Will the I-693 be provided in a sealed USCIS envelope?
Six-Step Appeal Quick Reference Guide
1. Determine whether you need a U.S. civil surgeon or an overseas panel physician.
2. Locate the approved provider through the official USCIS or consular process.
3. Bring complete vaccination, identity, and relevant medical records.
4. Complete the age-appropriate examination, TB screening, vaccinations, and other required testing.
5. Receive the completed I-693 in the required sealed envelope and keep your personal copy.
6. Follow the current USCIS validity and filing rules instead of relying on older two-year I-693 guidance.
Last Verified
2026-09-14
Content Note
Immigration medical requirements can change through USCIS policy updates and CDC Technical Instructions. The information here reflects the current guidance checked on September 14, 2026. The I-693 validity policy changed in June 2025, so older two-year-validity content should not be reused. Civil-surgeon requirements and fees vary, and consular immigrant-visa applicants generally follow a separate panel-physician process. This guide is educational and is not immigration, medical, tax, or legal advice.
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Common Pitfalls to Avoid
- ❌ Calling every immigration medical exam a pre-entry exam✓ Adjustment-of-status applicants in the U.S. generally use civil surgeons, while immigrant-visa applicants abroad generally use panel physicians.
- ❌ Saying I-693 is valid for two years✓ USCIS changed the validity policy in June 2025. The form is generally valid only while the associated immigration benefit application remains pending.
- ❌ Saying every green-card applicant must receive every vaccine listed by CDC✓ The civil surgeon applies age-specific requirements using current CDC vaccination instructions.
- ❌ Saying everyone age 2+ can use IGRA or TST interchangeably✓ Current civil-surgeon instructions require IGRA for applicants age 2 and older; TST is reserved for certain children under 2.
- ❌ Saying everyone over 15 automatically gets a chest X-ray✓ Chest X-ray is triggered by specified circumstances such as positive IGRA, known HIV infection, or TB signs/symptoms.
- ❌ Saying the civil surgeon decides whether someone gets a green card✓ The civil surgeon performs and documents the medical examination; USCIS decides the immigration application.
- ❌ Publishing $200–$500 as the official exam price✓ Civil-surgeon fees are private-provider charges and vary by location and applicant requirements.
- ❌ Assuming all vaccines must be completed before the exam✓ The civil surgeon generally gives the required dose(s) needed at the exam; complete multi-dose series according to the applicable schedule.
- ❌ Opening the sealed I-693 envelope✓ Keep the USCIS envelope sealed; retain the separate personal copy.
- ❌ Assuming a chronic disease automatically causes immigration inadmissibility✓ The medical exam focuses on specified health-related grounds of inadmissibility.
- ❌ Treating HIV as an automatic immigration medical barrier✓ HIV infection was removed from the health-related inadmissibility grounds and HIV testing is not a required component of the civil-surgeon exam.
Expat Checklist
- 📋 In-Network: Confirm your doctor is inside the PPO Network before booking appointments.
- 🔍 Brochure: Always read the detailed certificate of insurance.
- 🚨 Emergencies: Understand differences between urgent care and emergency room costs.
🔗 Related Healthcare Guides
Related US Tools & Guides
❓ Frequently Asked Questions
Official June 11, 2025 policy change replacing the old blanket two-year I-693 validity rule.
Official instructions for Form I-693, including designated civil surgeons, medical examination, submission, sealed-envelope requirements, and applicant documentation.
Official USCIS tool for locating designated civil surgeons.
Official CDC technical-instruction index covering medical history, physical examination, TB, vaccinations, mental health, syphilis, gonorrhea, Hansen's disease, and other medical conditions.
Current IGRA, chest-X-ray, age, and TB-classification requirements for civil-surgeon examinations.
Current age-specific vaccine requirements, documentation, immunity, foreign vaccination records, contraindications, and blanket-waiver rules.
Current physical and mental-status examination requirements.
Official distinction between overseas panel-physician examinations and U.S. civil-surgeon examinations.