No matter your route to getting a green card USCIS requires all immigrants to go through a medical exam. As with everything in regard to immigration, there are specific protocols and regulations for a USCIS medical exam. Learn everything you need to know about the exam here. The process of becoming a United States permanent resident is usually long. It can begin in the U.S., but it can also begin abroad (in the case of consular processed applications). The immigration medical exam is a key step that you must complete before immigrating. Many green card applicants become nervous at this stage, but there’s no need to worry. Here is what you need to know about this part of the immigration process. What is an Immigration Medical Exam? A lawful permanent resident of the United States can get such status based on: \tFamily relations \tHumanitarian reasons \tDiversity lottery \tEmployment sponsorship \tPersonal investment You must take the green card medical exam regardless of the basis on which you seek green card status. A government-designated doctor administers the exam, which consists of: \tA physical and mental evaluation \tDrug and alcohol screening \tA review of your medical history and immunization records \tTests for various diseases and illnesses You have to take a medical examination to ensure that you have no health-related grounds that deem you inadmissible to the United States. This guide will help you prepare for every stage of the USCIS medical exam process. Read and follow the instructions in this guide. It is also advisable to have an independent attorney review and support your application. The Green Card Medical Exam Process Depending on where you are filing your application, you will either be in the consular processing flow or filing for an adjustment of status. If You Are in The United States You will need to make an appointment with a USCIS-designated civil surgeon for your medical examination. The Center for Disease Control and Prevention (CDC) has issued technical instructions for these examinations. Civil physicians or doctors use these instructions to examine immigration applicants. The physician will start by matching your identity to the one on your passport or government I.D. to ensure they are screening the right person (do not attempt fraud). Next, they'll review your vaccination records to check that you are up-to-date on all the required shots outlined by USCIS. They'll then review the medical record that you've brought with you to see how many times you have been hospitalized; if you have a mental or chronic illness and are in a functioning state. They may ask you about your history with drugs or alcohol, past employment history, military records, traumas, etc. The results are sealed in an I-693 form. The applicant also receives a copy from the civil physician. The doctor may refer for diagnosis or classification to another physician or a health department if required to do so based on the CDC’s guidelines. If the USCIS determines that your I-693 is deficient, the USCIS sends a letter to the applicant. This letter requests the applicant to submit additional evidence. It may also ask that the doctor correct the medical examination results. Once you have submitted your application with USCIS, it will decide on your adjustment of status application. If there are no grounds for inadmissibility, the application is likely worthy of approval. USCIS Medical Exam for Adjustment of Status An adjustment of status is the path available to you if you currently live in the United States. You have to file the Application to Register Permanent Residence or Adjust Status (Form I-485). You should file this with the USCIS office responsible for your jurisdiction. In this case, a USCIS-designated civil physician will conduct a medical examination. This will be recorded on the Report of Medical Examination and Vaccination Record (Form I-693). Consular Processing Outside the United States Consular processing is the path that you will take if you are not in the United States. In this case, you file the application with the U.S Department of State (DOS) for an immigrant visa at a U.S. embassy or consulate abroad. The DOS-designated panel physician will conduct a medical examination. The results of this exam will be part of the Medical Examination for Immigrant or Refugee Applicant form. How to Find a Designated Civil Surgeon or Panel Physician for Green Card Medical Exam For applicants submitting Form I-693 and filing for an adjustment of status (I-485), please go to USCIS Find a Doctor. This will help you find a USCIS-designated civil doctor. For applicants applying abroad, please visit the Department of State website to find a local panel physician for your area of residence. Report of Medical Examination and Vaccination Record (Form I-693) Before your medical examination, you can fill out Part 1, “Information About You,” of Form 1-693. Remember: do not sign it until the civil doctor tells you to sign it. You must sign it in the presence of the doctor. From here on in, you merely attend your USCIS medical exam appointment and all follow-up examinations the doctor may require. If you have previous medical records on hand, including vaccination records, take them with you. Form I-693 comes in a sealed envelope. If the envelope is opened or altered in any way, USCIS will return the form to you, so do not accept Form I-693 unless it is in a sealed envelope. The doctor should also give you a copy of the completed Form I-693. You will need to submit your completed Form I-693 in a sealed envelope to USCIS. Follow the instructions on Form I-485, Application to Register for Permanent Residence or Adjust Status. All other applicants undergoing consular processing must follow the instructions that the office requesting the medical examination gives them. Preparing for Your USCIS Medical Exam It is best to have as much relevant documentation as possible to reduce the chances of a delay in your application. These are some of the important documents you should bring to your medical exam: \tA full copy of your medical history \tVaccination and immunization records \tAny previous copies of chest X-rays \tIf you have a health condition, then it is advisable to bring your regular doctor’s letter outlining a treatment plan \tGovernment-issued photo ID to verify your identity \tFunds to pay for your medical exam are not USCIS-regulated. Fees may vary across different USCIS jurisdictions and geographic locations \tHealth insurance cards accepted by the medical office Referrals by the Civil Doctor The USCIS-designated civil doctor may require further testing and assessment. This can happen during your medical examination. This happens when they feel that they need to conduct further evaluation or treatment. The doctor will specify the type of examination they want you to undergo. They will also tell you which additional tests or treatments you should undergo. The I-693 is not signed or dated by the doctor until the applicant has met all health-related follow-up requirements. Any additional evaluations and tests must be completed, as well. Medical Conditions and Inadmissibility The USCIS, the Department of Health, and the CDC provide up-to-date information to civil surgeons and panel physicians on what constitutes medical inadmissibility. Class-A medical conditions that render an applicant inadmissible on health-related grounds include: \tCommunicable diseases of public health significance \tFor permanent resident applications, a failure to show proof of required vaccinations \tPhysical or mental disorders that may result in harmful behavior \tSubstance abuse and substance abuse-related physical or mental disorders Class-B conditions are physical or mental conditions, diseases, or disabilities. They must be serious in degree or permanent in nature to qualify as Class-B conditions. An applicant in this category of medical conditions does not become inadmissible. However, the medical condition may be relevant to other grounds of inadmissibility. What Are the Tests Conducted at the Immigration Medical Exam? The immigration medical exam consists of your physical examination, medical review, chest X-ray, as well as blood tests for syphilis. For the physical exam, at the very least, you should expect an examination of the ears, eyes, nose, and throat, heart, extremities, lungs, lymph nodes, abdomen, and skin. In addition, for all green card applicants age 15 or older, the medical exam doctor must perform a blood test for syphilis and a urine test for gonorrhea regardless of whether the applicant is applying in the United States or abroad. The immigration medical exam is not a complete physical exam. It cannot replace your full physical exam, diagnosis, consultation, or treatment plan you may need from your primary health care provider. Its only purpose is to screen for certain medical conditions for the completion of your immigration application process. The physician is not required to screen you for any other conditions except the ones specified by the United States Public Health Services for immigration purposes. Will Children Also Need These Tests? No, children under the age of 15 are usually not required to undergo chest X-rays and blood tests during the immigration medical exams. Submit a Complete Form I-693 Any Form I-693 submitted to USCIS must meet the following requirements: \tThe form must be legible. \tAll required parts of the form must be complete, except those not needed by the civil physician. \tThe designated doctor who conducted the medical examination must sign and date the form. \tThe examined applicant must sign and date the form. \tIf the applicant requires further diagnosis or testing, the physician(s) completing referral evaluations must sign and date the evaluation. \tThe form must still be valid for filing. See details below on what the time frames for this are. \tThe form must be in a sealed envelope as detailed in the form’s instructions. If the above requirements are not met, or if there is evidence that the envelope has been tampered with, USCIS will return the original form to the applicant for corrective action. Validity Period for the Report of Medical Examination and Vaccination Record (Form I-693) Effective August 12, 2021, USCIS is temporarily extending the validity period of an otherwise valid Form I-693 in cases where the civil surgeon’s signature on Form I-693 is dated no more than 60 days before the applicant files Form I-485; No more than 4 years have passed since the date of the civil surgeon’s signature; and the decision on Form I-485 is issued on or before September 30, 2021. Medical Examination Fees The USCIS does not regulate the medical fee. It depends on the doctor or institution conducting the medical examination. Rates can vary by physician. You need to check with your local jurisdiction or the approved physician or medical facility for current rates. However, the cost ranges from $100 to $500. Vaccination Requirements Vaccination is an important part of the medical examination that an applicant filing for an I-485 or seeking an immigrant visa from an embassy abroad must satisfy. Certain scenario-specific factors related to vaccinations can come into play. One example is age, and another is allergic reactions to vaccinations. When vaccination requirements and expectations are set or scrutinized by USCIS, they consider issues of this nature. United States immigration laws require vaccinations to prevent the diseases in the list below. This applies to foreign nationals who apply for an immigrant visa abroad. It also applies to foreign nationals seeking an adjustment of status to a permanent resident status while in the U.S.: \tMumps \tMeasles \tRubella \tPolio \tTetanus and Diphtheria Toxoids \tPertussis \tHaemophilus influenza type B \tHepatitis B \tAny other vaccine-preventable diseases recommended by the Advisory Committee for Immunization Practices The CDC publishes technical instructions for civil doctors. These instructions outline how to handle various requirements and scenarios on a case-by-case basis. This applies to all medical exam applicants. In addition, the doctor will note down any other relevant points, and objections to receiving vaccinations will be recorded. Finally, the doctor's medical report will mention these observations and facts. Update If you are a non-U.S. citizen who is a nonimmigrant (not a U.S. citizen, U.S. national, lawful permanent resident, or traveling to the United States on an immigrant visa), you will need to show proof of being fully vaccinated against COVID-19 before you travel by air to the United States from a foreign country. K or V Category Visa for Adjustment If you have come into the United States and have completed a medical examination before your arrival, then generally, there will be no requirement to redo the medical exam provided the following hold true: \tThe applicant files for Form I-485 within one year of an overseas medical examination; and \tThe panel physician did not find a Class-A medical condition during the overseas examination; or \tThe panel physician did find a Class-A medical condition, and the applicant received a waiver of inadmissibility and has complied with the terms and conditions of the waiver. Proof of compliance with vaccination requirements is necessary even if a new medical examination is not required. If this is not provided, the doctor will complete the vaccination assessment part of Form I-693. Refugees Applying for Adjustment All refugees must comply with the vaccination requirements at the time of adjustment of status. They do this by submitting the relevant parts of the Report of Medical Examination and Vaccination Record (Form I-693) completed by the designated physician. In cases of overseas consular processing, medical exams are usually completed beforehand. As such, it does not need to be redone. However, if the panel physician discovers a Class-A medical condition, things change. You must repeat the entire examination if you have a Class-A medical condition. Family members who want to adjust their status and have refugee status in the United States must also undergo a medical examination. A civil doctor who is handling the medical examination may require further tests. Situations in which a medical exam has already been previously completed are also included. They can also order vaccinations to cover the requirements of undergoing a medical examination. Asylees Applying for Adjustment Any asylee to the United States must undergo an immigration medical exam. This includes a vaccination assessment at the time of filing for an adjustment of status. However, under certain circumstances, you may not have to repeat an exam. For example, this applies if your medical examination took place overseas and: \tThe results of the overseas medical examination in the A-file did not report a Class-A condition; \tThe asylee has applied for an adjustment of status within one year of eligibility to file; and \tSpecific evidence in the A-file or testimony given at the interview that there is no evidence that the asylee acquired a Class-A condition after they entered into the United States. *A-Files contain all records of any active case of an alien not yet naturalized. This applies to them as they pass through the U.S. immigration and inspection process. You must establish compliance with the vaccination requirements. The applicant must submit the vaccination assessment with the adjustment of status application. In addition, the applicant must have the relevant parts of Form I-693 completed by the civil doctor to comply with the requirement. Best Time to Complete the I-485 USCIS Medical Exam You may be wondering when is the best point in time to prep and submit to USCIS the I-693 medical exam. So as you know, it is required to submit your I-693 for approval of your I-485, but that does not mean it needs to be submitted with the initial I-485 application filing. What's more, USCIS will not reject an I-485 filing if it does not include the I-693 medical exam documents with it. However, it is required to submit for the I-485 to be approved. Below is the chart that outlines the timeline validity for Form I-693 medical examples for cases (1-485) submitted after November 1, 2018. Effective August 12, 2021, USCIS is temporarily extending the validity period of an otherwise valid Form I-693 in cases where: \tThe civil surgeon’s signature on Form I-693 is dated no more than 60 days before the applicant files Form I-485; \tNo more than 4 years have passed since the date of the civil surgeon’s signature; and \tThe decision on Form I-485 is issued on or before September 30, 2021. So what is the best time to complete the USCIS medical exam? Well, based on the chart, an I-693 stays valid for 2 years from the date the civil surgeon signs it, so you could either submit it at the initial filing of the I-485 application or within that two-year window, but since USCIS is handling such a huge caseload at the moment, it may not be in your best interest to send the medical proactively. If your situation permits, submit the medical exam when USCIS asks for it with an RFE. If you are asked for it at an interview, have it readily available. Again, your lawyer will best be able to advise the most suitable course of action for your case. Applicants may submit the Form I-693 medical examination report to USCIS: \tConcurrently with the immigration benefit application; or \tAt any time after filing the immigration benefit application but before USCIS finalizes adjudication of that application. If not submitted simultaneously with the immigration benefit application, applicants may bring the medical examination report to an interview or wait until USCIS issues an RFE requesting the medical examination report. Place of Submission of the Medical Examination Report The medical examination report should be submitted to the appropriate location. If you send it proactively you may mistakenly send it to the wrong USCIS office address which can add additional processing delays and issues to your case. If USCIS specifically requests your immigration medical exam then they will specify exactly where to submit it. Immigration Medical Exam: Frequently Asked Questions Who is required to get the immigration medical exam? This is required for all those filing Form I-485, Application to Register Permanent Residence or Adjust Status. What kind of doctor do I have to see? If you are in the United States and applying, you need to have a civil surgeon perform the medical exam. USCIS determines these civil surgeons. If you are overseas and applying, you need to see a panel physical authorized by the United States Department of State (DHS). You can easily locate a doctor near you (in the U.S.). How much does the exam cost? Prices for the medical exam can vary anywhere from $100-$500. Before selecting a doctor, you can ask them about their doctor's fees and if they accept your insurance carrier. There is no cost to file Form I-693. How do I schedule the appointment with the doctor? The easiest way is to use this USCIS tool to find a doctor authorized by U.S. Citizenship and Immigration Services. You can also call 1-800-375-5283 to find a civil surgeon who is authorized. Contact the doctor of your choice and ask them to schedule a medical examination for your immigration case. If you need to schedule the medical exam from overseas, you can do so only after receiving your green card interview appointment letter from the National Visa Center. Do not try to complete the exam before you are notified of your green card interview date. You can locate an authorized doctor for the exam by contacting the U.S embassy or consulate in your area. My priority date is soon-to-be current. Should I prepare for my medical exams? If you are an I-485 applicant and have a priority date that will most likely be current soon (up to four years with the COVID extension), then it could be a good choice to have the medical exam ready to go in a sealed I-693 medical exam envelope. Is there an extension to I-693 validity with COVID delays? Yes, as of August 12, 2021, USCIS will extend the validity in the following cases: \tThe civil surgeon’s signature on Form I-693 is dated no more than 60 days before the applicant files Form I-485; \tNo more than 4 years have passed since the date of the civil surgeon’s signature; and \tThe decision on Form I-485 is issued on or before September 30, 2021. What items do I bring with me to the exam? When you go to your medical exam, bring with you: \tVaccination or immunization records \tCopies of your medical history including chest x-rays, if applicable \tGovernment-issued ID (passport, driver's license, travel permit, etc.) \tLetter from your doctor if you are receiving any current treatment \tFunds to pay for the medical exam \tHealth insurance card, if the doctor accepts your insurance \tForm I-693, Report of Medical Examination and Vaccination Record (if applying in the U.S.) \tGreen Card Interview appointment letter from the NVC if you are applying overseas What if an applicant has a learning or intellectual disability? Immigration applicants with any intellectual or learning disabilities will need to provide a report for their condition. They will also have to provide any special supervision or educational requirements for the exam. What if I am missing some of the required vaccines? If you do not have some of the required vaccines, you will be required to get them before attending your green card interview. During the medical exam, the doctor can also administer them. What if an applicant has a positive tuberculosis skin test? Applicants who have a previous positive skin test for tuberculosis must present a certificate from the attending doctor to the civil physician in charge of their immigration medical exam. The certificate must explain the circumstances of the positive result, the prescribed treatment for the condition, and the duration of the treatment. If an applicant has ever been diagnosed with tuberculosis, that applicant will have to provide a written certification, signed by the attending doctor, to prove that they have been adequately treated. The certificate must also include types and dates of medications taken. What if an applicant has an abnormal chest X-ray? Applicants who had ever had an abnormal chest X-ray must borrow the last X-rays films they took and bring them to the designated physician for the immigration medical exam. The physician may need the actual films (not the typed reports) to compare with the applicant's X-rays at the immigration medical exam. What if an applicant has syphilis? Applicants who have ever had syphilis will have to present a written certificate signed by a public health official or doctor to prove they were adequately treated. In addition, applicants who have ever had a case of positive VDRL or any other blood test for syphilis and were not treated will have to give a detailed written explanation signed by their doctor to the designated immigration medical exam physician. What if an applicant has a history of violent behavior or a psychiatric condition? If an applicant had any history of violent or harmful behavior, resulting in injury or harm to people, animals, or inanimate objects, they would have to provide a report that will help the physician determine if the behavior was related to a medical or psychiatric issue, or drug or alcohol use. Such behaviors include self-harm or suicide attempt(s), regardless of how minor in nature. If you had been hospitalized or treated for a mental or psychiatric condition or substance abuse, you must present a written certification detailing the diagnosis, duration of treatment, including prognosis. What happens after the medical exam? What happens afterward varies depending on your country of origin. In some countries, the physician will seal the medical exam results in an envelope and hand it over to you (the immigration applicant) to take with you to your visa interview. For some other countries, the physician will send it directly to the embassy. If the results are given to you, do not open them. You must take them to the interview sealed, along with other documents for the interview. In most cases, the results of the immigration medical exam are valid for up to two years. Can the immigration medical exam and/or vaccinations be waived? Generally, the medical exam is compulsory if it is part of the requirements for the visa category you are pursuing. However, if there is a medical reason for you not to have completed any vaccination out of the required vaccinations for your visa application, certain waivers can be granted upon the recommendation of the civil physician. Can I complete my medical exam in the U.S. if I pursue a visa application abroad, but I’m physically present in the U.S.? No, you may not be allowed to have your medical exam in the United States if you are processing a visa at an embassy or consulate abroad. According to the DOS, if you have a pending visa application at a U.S. embassy or consulate abroad, your immigration medical exam must be done by the civil physician approved by the U.S. embassy or consulate processing your visa. Will pregnant women need X-rays? As required by the U.S. Centers for Disease Control and Prevention (CDC), pregnant women who need an immigration medical examination and are being examined in a country using the 2007 TB Technical Instruction must have a chest x-ray exam conducted. The pregnant applicant will have to provide the civil physician with consent to have the chest x-ray. The civil panel is also required to provide the pregnant woman with pelvic and abdominal protection. Can a pregnant applicant postpone the chest X-ray until after pregnancy? Yes. According to the CDC, a visa applicant may postpone the required chest x-ray and (immigration medical exam) until after pregnancy. However, the X-ray must be completed before the applicant immigrates to the United States.