Trusted immigration legal services for families, couples, and professionals seeking permanent residency in the United States.
I‑693 Medical Exam for Green Card Applicants: Complete 2026 Guide
During the application for a U.S. Green Card through Adjustment of Status (AOS), one of the most important steps is completing the Form I-693 medical examination. This exam confirms that applicants meet U.S. public health requirements, including mandatory vaccinations and screening for specific communicable diseases.
This guide explains everything you need to know about the 2026 I-693 process, including how to prepare, what documents are required, what to expect during the medical exam, and how the form is submitted with Form I-485. All information is based exclusively on official USCIS and CDC guidance, ensuring accuracy and reliability.
What Is the I‑693 Medical Exam
Form I-693 is a medical examination report completed by a USCIS-designated civil surgeon. Its purpose is to confirm that an applicant is not inadmissible on health-related grounds. Specifically, the exam verifies that:
You do not have certain communicable diseases of public health significance.
You have received, or can document immunity to, all required vaccinations.
You do not have a physical or mental condition that poses a public health risk.
This medical exam is required for most Green Card applicants who are applying while staying in the United States, although certain exemptions apply. Even applicants who previously completed an overseas medical exam may still need a civil surgeon’s review in the U.S. to verify vaccination records and complete Form I-693. Understanding how the medical exam requirement fits within the overall green card application process can help ensure your application is complete and avoid unnecessary delays.
Understanding Which Immigration Medical Exam Applies to Your Green Card Process
Every applicant for a U.S. Green Card is required to complete an immigration medical exam, but the name of the form, the type of doctor involved, and how the exam is submitted depend on how and where the Green Card application is filed. This distinction often confuses.
Adjustment of status
Applicants who apply from inside the United States use a process called Adjustment of Status. In this case, the medical exam is documented on Form I-693, which must be completed by a USCIS-designated civil surgeon and submitted to USCIS, usually together with Form I-485. This is the scenario most people are referring to when they talk about the “I-693 medical exam.”
Consular Processing
Applicants who apply from outside the United States go through consular processing. They are still required to complete a medical exam, but it is performed by a panel physician approved by the U.S. embassy or consulate, not a civil surgeon. The medical results are submitted directly to the embassy using embassy-specific medical forms, rather than Form I-693.
In certain situations, an applicant may have already completed a medical exam overseas and later file for an adjustment of Status in the United States. In those cases, USCIS may accept parts of the prior exam, but a civil surgeon review is often still required, particularly to confirm vaccination records and properly complete Form I-693. Whether a new exam is needed depends on timing, documentation, and USCIS policy in effect at the time of filing.
In summary, the medical exam itself is a universal Green Card requirement, but Form I-693 is used only for Adjustment of Status applications filed within the United States. Understanding which process applies to your case helps ensure the correct medical exam is completed and submitted without delays.
Preparing for Your I‑693 Medical Exam
1. Gather Required Documents
Before your appointment, bring:
- A government-issued photo ID (passport or driver’s license).
- Vaccination records (including childhood immunizations and any vaccines received overseas).
- Medical records for ongoing conditions or previous illnesses.
- Completed but unsigned Form I‑693.
- If applicable, any DS‑3025 or overseas panel physician forms.
2. Understand Required Vaccinations (2026 Update)
The CDC requires documentation for the following, depending on age and health history:
- Diphtheria, Tetanus, Pertussis (Tdap)
- Polio (IPV) – updated requirement effective 2024 applies to all ages
- Measles, Mumps, Rubella (MMR)
- Hepatitis A & B
- Varicella
- Pneumococcal disease
- Influenza
- Hib and meningococcal vaccines were applicable.
Note: COVID‑19 vaccination is no longer required for I‑693 exams as of 2025 according to USCIS update.
If you lack official records, your civil surgeon may:
- Administer the required vaccines or the first dose in a series.
- Conduct blood tests (titers) to confirm immunity.
3. Consider Costs and Fees
- USCIS does not charge a fee for the I‑693 form itself.
- Civil surgeons typically charge for the exam, tests, and vaccinations.
- Insurance may cover vaccinations, but often not the exam fee. Always confirm costs with your provider.
4. Tips to Avoid Delays
- Schedule your exam close to your I‑485 filing date, because I‑693 validity is limited to the pending I‑485 application.
- Bring as much documentation as possible, including overseas records.
- Confirm the civil surgeon is using the latest edition of Form I‑693 (01/20/25 edition).
What Happens During the I‑693 Medical Exam
- Medical History Review
The civil surgeon will ask about:
- Past illnesses, surgeries, or chronic conditions
- Allergies and medications
- Symptoms that could indicate communicable diseases
- Physical Examination
- General health evaluation (heart, lungs, abdomen, etc.)
- Height, weight, and vital signs measurement
- Communicable Disease Screening
- Tuberculosis (TB): Blood test (IGRA) for ages 2+, chest X-ray if positive.
- Syphilis: Required for adults 18–45, blood test administered.
- Gonorrhea: Lab test performed when indicated.
- Vaccination Review and Administration
- The surgeon checks your vaccination records against CDC requirements.
- Missing vaccines may be administered during the exam.
- Only the first dose of the multi-dose series is required for USCIS completion.
- COVID-19 Section (2026 Update)
- Civil surgeons mark this as N/A, since it is no longer required.
Submitting Form I‑693 with Your Green Card Application
- Civil Surgeon Responsibilities
- Must conduct the exam in person.
- Complete Form I‑693 accurately and sign it.
- Cannot delegate the signature to another doctor.
- The Sealed Envelope Rule
- USCIS requires that Form I‑693 remain in a sealed envelope.
- Opening it before submission can result in rejection.
- Submission With Form I‑485
- As of December 2024, you must include Form I‑693 when filing Form I‑485, if required.
- Failure to include it may result in rejection or an RFE.
- Validity Rules (2025–2026 Update)
- Any Form I‑693 signed on or after Nov. 1, 2023, is valid only while the associated I‑485 is pending.
- If your application is denied or withdrawn, you must obtain a new medical exam andan I‑693 for a new filing.
Common I- 693 Medical Exam Mistakes to Avoid
- Using outdated Form I‑693 editions.
- Failing to bring vaccination records or ID.
- Submitting I‑485 without the sealed I‑693 envelope.
- Opening the envelope before submission.
- Scheduling the exam too early risks expiration before filing.
Special Possible Scenarios
- Prior Overseas Medical Exam (DS‑3025)
- Applicants who completed an immigrant visa medical exam overseas may still need a civil surgeon review.
- Vaccination records from overseas can reduce the need for additional shots, but they must meet CDC requirements.
- Children and Adolescents
- Vaccination schedules differ by age. Civil surgeons follow CDC age-specific guidance.
- Medical Conditions and Contraindications
- If a condition prevents vaccination, the surgeon marks a contraindication on Form I‑693 with supporting documentation.
Conclusion
The Form I-693 medical exam is a critical part of your Green Card application. Preparing properly, understanding vaccination requirements, completing the exam in person with a USCIS-designated civil surgeon, and submitting the sealed Form I-693 with your Form I-485 are all essential steps to avoid delays. Knowing where the medical exam fits within the green card application timeline can also help you plan your application more effectively.
Always refer to official USCIS and CDC guidance for the most current requirements and instructions.
Frequently Asked Questions
When should I complete the I-693 medical exam for a Green Card application?
USCIS currently requires most applicants to submit Form I-693 at the same time as Form I-485. Completing the medical exam too early may result in the form expiring if your application is delayed. For this reason, many applicants schedule the exam shortly before filing their adjustment of status application, following current USCIS instructions.
Do I need to submit Form I-693 with Form I-485 in 2026?
Yes. Under current USCIS policy, applicants who are required to submit Form I-693 must include it with their initial Form I-485 filing. If the medical exam is missing, USCIS may reject the application or issue a Request for Evidence (RFE), which can significantly delay processing.
What vaccinations are required for the I-693 medical exam in 2026?
Vaccination requirements are determined by the CDC’s Technical Instructions and vary by age and medical history. Commonly required vaccines include MMR, Tdap, polio, hepatitis A and B, varicella, and influenza. COVID-19 vaccination is not required as of the current USCIS and CDC guidance. A civil surgeon reviews all vaccination records during the exam.
What happens if I do not have vaccination records for the I-693 exam?
If you do not have written vaccination records, the civil surgeon may recommend vaccination during the exam or order blood tests (titers) to confirm immunity. USCIS does not require applicants to complete an entire multi-dose vaccine series before submitting Form I-693; generally, only the first required dose must be documented.
Can I use a regular doctor instead of a USCIS civil surgeon for the Green Card medical exam?
No. USCIS requires that Form I-693 be completed and signed only by a USCIS-designated civil surgeon. Exams performed by non-designated doctors, urgent care clinics, or telehealth providers are not accepted for immigration purposes.
How long is Form I-693 valid after the civil surgeon signs it?
For forms signed on or after November 1, 2023, Form I-693 is valid only while the associated Form I-485 remains pending. If the adjustment of status application is denied or withdrawn, the medical exam is no longer valid, and a new I-693 will be required for any future filing.
What medical conditions can cause problems during the I-693 immigration medical exam?
Certain communicable diseases, such as active tuberculosis or untreated syphilis, may require further evaluation or treatment before the medical exam can be certified. Having a medical condition does not automatically disqualify an applicant; USCIS reviews the civil surgeon’s findings in accordance with CDC public health guidance.
This information is for general educational purposes only and is not legal advice. Reading this page does not create an attorney–client relationship. Immigration laws change frequently, and your situation may require personalized guidance.
Ready to Start Your Green Card Journey?
Get personalized guidance from an experienced green card lawyer.