Form I-693 counts only when a USCIS-designated civil surgeon signs it. What the exam covers, vaccinations and waivers, the sealed envelope, validity and cost.
Reviewed by Ekaterina Fitenko, Esq. — Florida Bar #1064536. With 20+ years of experience in the legal field, she advises adjustment-of-status applicants on the medical examination and on the health-related grounds of inadmissibility, in English and Russian.
Form I-693, Report of Immigration Medical Examination and Vaccination Record, is valid only when it is completed and signed by a physician whom USCIS has designated as a civil surgeon. An examination by any other doctor does not count — not your primary care physician, not a specialist who has treated you for years, not a clinic that advertises immigration physicals without holding the designation.
This is the most expensive mistake in the topic. The applicant pays for a full physical, collects a signed form, and files it with the green card application. Months later USCIS issues a Request for Evidence saying the examination was not performed by a designated civil surgeon, and the whole exam has to be repeated and paid for again. Nothing about the first doctor's competence is in question; the designation is an administrative status USCIS grants to individual physicians, and a form signed without it is treated as if no exam happened.
The examination attaches to essentially every application for adjustment of status. If you are preparing a green card case from inside the United States, plan the I-693 alongside the Form I-485 package rather than after the rest is assembled.
USCIS publishes the authoritative list through its Find a Doctor tool, which returns designated civil surgeons by ZIP code and search radius. That tool is the only reliable source. A clinic's website or a listing on a directory site is not verification — check the name against the USCIS tool before you book, and again before you pay.
Two details trip people up. First, holding a Florida medical license and holding a civil surgeon designation are different things: designation is a separate application to USCIS, and most licensed doctors have never sought it. Second, designation belongs to the individual physician, not the practice. A clinic may employ eight doctors and have exactly one civil surgeon among them, and if a colleague performs the exam that day, the form is worthless. When you schedule, ask who will personally sign the form and confirm that name against the tool.
Certain military physicians may perform the examination for service members and their qualifying relatives under a separate authority. That is a narrow exception and does not extend to civilian doctors of any kind.
The civil surgeon is not your doctor for this appointment. The physician is assessing whether you fall under one of the health-related grounds of inadmissibility in section 212(a)(1) of the Immigration and Nationality Act, and reporting the answer to USCIS. Nothing said there is treatment, and the physician has no duty to follow up on anything found.
The examination has four components. The physician reviews your vaccination history against the immigration schedule; screens for tuberculosis; screens for the other communicable diseases of public health significance, which currently means infectious tuberculosis, untreated syphilis, untreated gonorrhea and infectious Hansen's disease; and asks about physical or mental disorders with associated harmful behavior and about drug use. That disease list is set by the Centers for Disease Control and Prevention and has narrowed over the years — HIV infection was removed in 2010 and is no longer screened for or reported.
Tuberculosis screening follows the CDC Technical Instructions rather than ordinary clinical practice. Since 2018 those instructions require a blood test, an interferon-gamma release assay, for applicants aged two and older, in place of the older tuberculin skin test. A positive blood test is not a finding of tuberculosis; it triggers a chest X-ray, and only an abnormal X-ray leads anywhere further.
The mental-health and drug questions deserve caution. The physician is required to ask about substance use and past psychiatric diagnoses, and the answers become part of a federal filing. Anyone with a history worth discussing — an old drug charge, a hospitalization, a diagnosis on record — should raise it with counsel before the appointment, not after the form is sealed.
The immigration vaccination requirement is its own schedule, set by CDC for immigration purposes, and it does not match what a state or a pediatrician's office requires. The list changes — vaccines have been added and removed — so the working rule is that the civil surgeon applies the CDC Technical Instructions in force on the day of the exam, not a list published in an article.
Bring documentation. A vaccine you received but cannot document does not count, and a parent's recollection is not a record. Useful sources are your childhood immunization card, school or military records, and printouts from the immunization registry of the state where the shots were given. A foreign-language record usually needs no translation for the civil surgeon, who reads dates and vaccine names, but a certified translation is worth having if the record is handwritten or unclear.
Missing vaccinations are usually not a bar. The civil surgeon ordinarily administers what is missing at the appointment, or asks you back for a second dose where the schedule requires spacing, and then completes the form. Two waiver routes exist where a vaccine cannot be given:
The civil surgeon gives you the completed I-693 in a sealed envelope, and a broken seal invalidates it. Do not open it to check the contents, do not let anyone else open it, and do not submit a photocopy in place of the sealed original. If the envelope arrives at USCIS opened or resealed, the agency treats the form as unsubmitted. Ask the physician for a separate courtesy copy at the appointment — most will provide one, and it lets you verify what was reported without touching the seal.
There are two ways the sealed envelope reaches USCIS: filed together with the I-485, which is what USCIS encourages, or carried to the adjustment interview. Filing it concurrently is generally better, because it removes one reason for a Request for Evidence and puts the medical record in front of the officer while the file is being reviewed. If your case is already filed without it, bring the sealed envelope to the green card interview unless USCIS asks for it sooner.
A missing or defective medical exam is one of the most common triggers for a Request for Evidence in adjustment cases — fixable, but slow. If a notice has arrived, the deadline printed on it governs and does not extend; see our guidance on responding to a USCIS Request for Evidence.
This rule has changed more than once, so treat any figure you read — including this one — as something to confirm. USCIS has at times required the form to be submitted within 60 days of the civil surgeon's signature, and at other times treated a signed form as valid for two years. Both rules have been superseded.
As of September 2026, a Form I-693 that a civil surgeon properly completed and signed on or after November 1, 2023 does not expire, under the USCIS policy update announced in April 2024. USCIS still retains discretion to ask for a new or updated examination. Because the position has moved twice in recent years, confirm it on the official USCIS Form I-693 page before you rely on it for timing, and do not assume an exam signed before November 1, 2023 falls under the same rule.
The practical consequence is that stalling the exam to avoid an expiration no longer buys anything under the current rule. Getting it done and filed with the I-485 removes a step from the back end of the case.
Applicants who process an immigrant visa at a U.S. consulate abroad see a panel physician, not a civil surgeon, and the two designations do not substitute for each other. A panel physician is designated by the U.S. embassy or consulate for that country, and the examination is performed at or near the consular post shortly before the visa interview. The results go to the consular section directly rather than to USCIS on Form I-693.
The line matters when a case switches tracks. A civil surgeon exam done in Florida is not accepted by a consulate abroad, and a panel physician exam done overseas does not become an I-693 by being carried into the United States. If you are still weighing the two routes, the comparison is set out in adjustment of status versus consular processing, and our consular processing practice page explains how the National Visa Center stage fits around the medical appointment.
One narrow overlap exists. An applicant examined by a panel physician abroad shortly before entering the United States may, in limited categories, need only the vaccination portion completed by a civil surgeon rather than a full repeat exam. K-1 fiancé(e) visa holders are the common example: their overseas exam did not include the immigration vaccination assessment, so that record still has to be completed here.
Very few adjustment applicants are exempt from the examination altogether. Refugees and certain others examined abroad within the year before filing may need only the vaccination portion, and specific humanitarian categories have their own rules. Age is not an exemption — children are examined too, with age-appropriate components.
If the physician does find something, the vocabulary matters. A Class B condition is a significant health condition that does not make you inadmissible; it is reported and the case proceeds. A Class A condition is one that falls within a ground of inadmissibility, and it is not automatically the end of the case. For a communicable disease, treatment often resolves the finding outright — treated syphilis is not untreated syphilis, and tuberculosis under a completed CDC-supervised treatment course is a different report. Where the finding stands, a waiver under section 212(g) of the Immigration and Nationality Act may be available for a communicable disease, for the vaccination ground, and for a physical or mental disorder with associated harmful behavior.
The exception is worth stating plainly: there is no 212(g) waiver for the drug abuse or drug addiction ground. That finding is generally overcome only by establishing sustained remission under the medical standards, which takes time and documentation, not by a waiver application.
The examination fee is set by each individual civil surgeon and is not a government fee, so it varies from office to office within the same county. USCIS does not publish it, cap it or collect it — you pay the physician directly, and the money is not refundable if your case is later denied. Call two or three offices from the Find a Doctor results and ask what the quoted price includes before booking.
Vaccinations are normally charged separately from the exam itself, per dose, and the tuberculosis blood test and any follow-up chest X-ray may also be billed apart. Ask specifically whether the quote covers the blood test, whether missing vaccines are extra, and whether a second visit for a spaced dose carries another charge. Health insurance sometimes covers the vaccines even when it does not cover the immigration examination, so ask the office to bill the two separately.
None of this is the USCIS filing fee, which is a separate line on your budget and is set by the government — those amounts are in the current USCIS fee schedule, and they change independently of anything a civil surgeon charges.
No, unless that doctor holds a USCIS civil surgeon designation. Check the name in the USCIS Find a Doctor tool. An exam by an undesignated physician has to be repeated in full, at your expense.
The form is invalid and USCIS will not accept it. You would return to the civil surgeon, who may charge to reissue a sealed copy, or repeat the exam. Ask for a courtesy copy at the appointment instead.
The civil surgeon administers the missing vaccines at the appointment. That is the routine outcome, not a problem with your case. Where the schedule requires spacing between doses, expect a second visit. A vaccine you cannot document is treated as not received.
No. A positive blood test leads to a chest X-ray, and most people with a positive test have latent infection and a normal X-ray, which is not a ground of inadmissibility. Only active infectious tuberculosis is, and completed CDC-supervised treatment changes the report.
As of September 2026, a form properly signed by a civil surgeon on or after November 1, 2023 does not expire under current USCIS policy, though USCIS may still request an updated exam. This rule has changed twice in recent years; confirm the current position on the USCIS Form I-693 page.
Usually yes, at least in part. A panel physician exam abroad is a different designation and does not become an I-693. K-1 fiancé(e) visa holders typically still need the vaccination record completed by a civil surgeon at adjustment.
$200 for 30 minutes, in English or Russian. Call (305) 315-3425 or email fitenkolaw@gmail.com to schedule.
This article is informational only and is not legal advice. Form editions, fees and processing times change; confirm current requirements with USCIS before filing. Reading this page does not create an attorney-client relationship.
Fitenko Law PLLC, 11555 Heron Bay Blvd, Suite 277, Coral Springs, FL 33076 (main office); 600 Three Islands Boulevard, Hallandale Beach, FL 33009 (by appointment only). Phone: (305) 315-3425. Email: fitenkolaw@gmail.com