Different people follow different steps to become lawful permanent residents (green card holders). You may file for an adjustment of status from within the U.S., or you can apply for an immigrant visa at an embassy or consulate. There are other ways you may also be able to immigrate as well. Regardless of your path, you must take an immigration medical exam. Learn everything you need to know about the exam here.
The process of becoming a United States permanent resident is usually a long process. 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:
- Family relations
- Humanitarian reasons
- Diversity lottery
- Employment sponsorship
- Personal investment
You must take the medical examination regardless of the basis on which you seek green card status.
A government-designated doctor administers the exam, which consists of:
- A physical and mental evaluation
- Drug and alcohol screening
- A review of your medical history and immunization records
- Tests for various diseases and illnesses
You have to take the medical examination to ensure that you have no health-related grounds that would deem you inadmissible to the United States. This guide will help you prepare for every stage of the 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 Immigration 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 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 make a decision on your adjustment of status application. If there are no grounds for inadmissibility, the application is likely worthy of approval.
Immigration Medical Exam for Adjustment of Status
An adjustment of status is the path that is 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). This should be filed 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 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 who are 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)
You can fill out Part 1 “Information About You” of Form 1-693 before your medical examination. 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 medical examination appointment and any 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 back 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 the sealed envelope to USCIS. Follow the instructions on Form I-485, Application to Register for Permanent Residence or Adjust Status.
All other applicants who are undergoing consular processing must follow the instructions that the office requesting the medical examination gives them.
Preparing for Your Medical Exam
It is best to have as much relevant documentation as possible in order to reduce the chances of a delay in your application. These are some of the important documents you should bring to your medical exam:
- A full copy of your medical history
- Vaccination and immunization records
- Any previous copies of chest X-rays
- If you have a health condition, then it is advisable to bring your regular doctor’s letter outlining a treatment plan
- Government-issued photo ID to verify your identity
- Funds to pay for your medical exam are not USCIS-regulated. Fees may vary across different USCIS jurisdictions and geographic locations
- Health 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 are responsible for providing 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:
- Communicable diseases of public health significance
- For permanent resident applications, a failure to show proof of required vaccinations
- Physical or mental disorders that may result in harmful behavior
- Substance 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.
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:
- The form must be legible.
- All required parts of the form must be complete, except those not needed by the civil physician.
- The designated doctor who conducted the medical examination must sign and date the form.
- The examined applicant must sign and date the form.
- If the applicant requires further diagnosis or testing, the physician(s) completing referral evaluations must sign and date the evaluation.
- The form must still be valid for filing. See details below on what the time frames for this are.
- The 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, the original form will be returned to the applicant for corrective action.
Validity Period for the Report of Medical Examination and Vaccination Record (Form I-693)
The USCIS is reducing the validity period of Form I-693 to 60 days from the date the doctor signs the I-693, previously a 1-year period of validity. What this means is that an applicant must ensure that he or she completes the medical examination close to their filing date for Form I-485 Application for Permanent Residence or Adjustment of Status. Once the USCIS has received your medical examination (Form I-693), it will be valid for a period of 2 years.
Medical Examination Fees
The medical fee is not regulated by the USCIS. 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 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.:
- Tetanus and Diphtheria Toxoids
- Haemophilus influenza type B
- Hepatitis B
- Any 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. The doctor will note down any other relevant point, and objections to receiving vaccinations will be recorded. The doctor’s medical report will mention these observations and facts.
K or V Category Visa for Adjustment
If you have come into the United States and have completed a medical examination prior to your arrival, then generally there will be no requirement to redo the medical exam provided the following hold true:
- The applicant files for Form I-485 within one year of an overseas medical examination; and
- The panel physician did not find a Class-A medical condition during the overseas examination; or
- The 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. In cases where 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. This applies if your medical examination took place overseas and:
- The results of the overseas medical examination in the A-file did not report a Class-A condition;
- The asylee has applied for adjustment of status within one year of eligibility to file; and
- Specific 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 their entry 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. To comply with the requirement, the applicant must have the relevant parts of Form I-693 completed by the civil doctor.
Immigration Medical Exam: Frequently Asked Questions
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 an applicant has a positive tuberculosis skin test?
Applicants who have a previous positive skin test for tuberculosis are required to 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 for 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 actual films (not the typed reports) may be needed by the physician to compare with the X-rays the applicant will take 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 as proof that they were adequately treated. 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) for you to take it 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. They must be taken 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’m pursuing 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 choose to 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.
How Our Immigration Attorneys Can Help You
The medical exam is an integral part of the immigration process. It comes with very specific requirements, filing times, and documentation proofs. Immi-USA’s team of experienced immigration lawyers has helped countless applicants with this step. We can guide through your medical exam in particular and immigration application as a whole.
To get in touch with one of our immigration attorneys, you can contact us by filling out this form and scheduling your consultation today.