Form I-693 Medical Examination
Most adjustment applicants must establish that they are not inadmissible under the health-related grounds in INA §212(a)(1). A USCIS-designated civil surgeon records the immigration medical examination and vaccination assessment on Form I-693. Current USCIS rules generally require applicants who must submit Form I-693 to file the required medical documentation with Form I-485, and a Form I-693 is generally valid only for the immigration benefit application with which it is submitted while that application remains pending.
What is Form I-693?
The civil surgeon makes the required medical classifications and records examination results. USCIS makes the legal determination of admissibility and whether a waiver or other immigration relief is available.
Health-related grounds of inadmissibility
The immigration medical examination addresses the health-related grounds in INA §212(a)(1).
These generally involve:
- Communicable diseases of public health significance;
- Failure to document required vaccinations;
- Certain physical or mental disorders associated with harmful behavior;
- Physical or mental disorders with a history of harmful behavior likely to recur; and
- Drug abuse or addiction.
Many ordinary medical conditions do not create an INA §212(a)(1) problem. The immigration consequence depends on the statutory ground and the CDC medical classification.
Only a designated civil surgeon can complete the domestic immigration medical
A normal primary-care physician cannot complete Form I-693 unless the physician has the required USCIS civil-surgeon designation or qualifies under a specific blanket-designation rule.
Before scheduling:
- Use the USCIS civil-surgeon search tool;
- Confirm the physician's designation;
- Ask what records to bring;
- Bring vaccination documentation;
- Bring government-issued photo identification; and
- Confirm whether follow-up testing may be required.
USCIS does not charge a filing fee for Form I-693 itself, but civil surgeons set their own examination and testing fees.
Current filing rule: submit required Form I-693 with Form I-485
USCIS revised the adjustment filing process beginning in late 2024.
For applicants required to submit Form I-693 or a required partial I-693, current USCIS filing rules generally require the medical documentation to accompany Form I-485.
The older practice of routinely filing Form I-485 without the medical and waiting for an interview or RFE is no longer appropriate for applicants subject to the current concurrent-medical filing requirement.
The exact requirement should be confirmed from the current Form I-485 instructions on the filing date.
The current I-693 validity rule changed in June 2025
USCIS changed its medical validity policy effective June 11, 2025.
Under current policy:
- A properly completed Form I-693 is generally valid for the immigration benefit application with which it was submitted while that application remains pending;
- If the associated immigration benefit is denied or withdrawn, the medical generally does not remain valid for an unrelated later benefit application;
- A new Form I-693 is generally required with a subsequent immigration benefit application; and
- USCIS can request updated medical evidence when circumstances warrant it.
USCIS's April 2024 policy allowing many Forms I-693 signed on or after November 1, 2023 to remain valid indefinitely was superseded by the June 11, 2025 policy.
The civil surgeon must use the current form and technical instructions
Before relying on a completed medical, verify:
- Correct Form I-693 edition;
- Civil surgeon designation;
- Applicant signature;
- Civil surgeon signature;
- Required testing;
- Vaccination assessment;
- Required follow-up;
- Correct completion of all applicable parts; and
- Proper submission format.
An outdated, incomplete, unsigned, or improperly completed medical can result in rejection, RFE, or delay.
Do not open the sealed medical envelope
Where the civil surgeon provides Form I-693 in the traditional sealed-envelope format, the applicant should not open or alter that envelope.
The civil surgeon should also provide the applicant a copy for personal records.
Review the applicant copy for obvious errors before filing while preserving the sealed USCIS copy exactly as instructed.
Vaccination records
The civil surgeon reviews the applicant's vaccination history under the CDC technical instructions.
Applicants should bring:
- Childhood vaccination records;
- Adult vaccination records;
- COVID-era vaccination records where part of the medical history;
- Laboratory immunity results where relevant;
- Prior immigration medical records; and
- Other reliable vaccine documentation.
If records are unavailable, the civil surgeon determines what vaccinations or other documentation are required under the current technical instructions.
COVID-19 vaccination is no longer required for adjustment
Effective January 22, 2025, USCIS stopped requiring adjustment applicants to present documentation that they received the COVID-19 vaccination.
USCIS does not deny Form I-485 on the ground that the applicant failed to document COVID-19 vaccination.
The COVID-19 change did not eliminate the statutory vaccination ground. Applicants must still satisfy the other vaccination requirements that remain applicable under INA §212(a)(1)(A)(ii) and the current CDC technical instructions.
Tuberculosis screening
The civil surgeon must follow current CDC tuberculosis technical instructions.
The process can involve:
- Required TB screening test;
- Chest radiograph where indicated;
- Sputum testing where required;
- Public-health reporting;
- Treatment documentation;
- Class A or Class B classification; and
- Follow-up with health authorities.
A positive screening test is not by itself the same as a Class A tuberculosis inadmissibility finding. The civil surgeon must complete the CDC-required diagnostic process and classification.
Class A and Class B findings
Immigration medical terminology distinguishes conditions that create inadmissibility from conditions that may require notation or follow-up without creating the same immigration bar.
| Classification | General Significance |
|---|---|
| Class A | A health condition that falls within an applicable INA §212(a)(1) inadmissibility ground. |
| Class B | A significant health condition that does not itself constitute the same Class A inadmissibility ground but may require documentation or follow-up. |
The exact immigration effect depends on the condition and the current CDC technical instructions.
Physical or mental disorders and harmful behavior
A physical or mental health diagnosis alone does not automatically create inadmissibility.
The immigration ground focuses on specified disorders associated with harmful behavior or a history of harmful behavior likely to recur.
The evaluation can consider:
- Medical diagnosis;
- Nature of prior harmful behavior;
- Recency;
- Severity;
- Treatment;
- Remission;
- Risk of recurrence; and
- Current medical evidence.
Applicants with relevant history should obtain records before the civil-surgeon examination rather than attempting to reconstruct treatment history later.
Drug abuse or addiction
The civil surgeon must evaluate drug abuse and addiction under the current medical standards incorporated into the immigration examination.
Relevant evidence can include:
- Substance-use history;
- Medical records;
- Treatment records;
- Rehabilitation records;
- Periods of remission;
- Prescription history; and
- Other clinical evidence.
A medical finding involving drug abuse or addiction and a criminal or controlled-substance inadmissibility ground are legally distinct and may require separate analysis.
Medical waivers
Some health-related grounds can be waived under INA §212(g) when the statutory requirements are satisfied.
Depending on the ground, a waiver can involve:
- Form I-601;
- Qualifying family relationships;
- Public-health conditions;
- Vaccination waivers;
- Religious or moral objections to vaccination;
- Treatment or monitoring requirements; and
- Other category-specific evidence.
A positive laboratory result or medical history does not automatically mean the applicant is legally inadmissible or needs Form I-601.
K-1, K-2, K-3 and K-4 applicants have special medical rules
K nonimmigrants normally completed an immigration medical examination before visa issuance.
Depending on timing and the overseas findings, the applicant may not need to repeat the entire medical examination.
The current I-693 instructions should be reviewed for:
- Date of the overseas examination;
- Date Form I-485 is filed;
- Whether a Class A condition was found;
- Vaccination compliance;
- Whether only portions of Form I-693 are needed; and
- Whether a complete new civil-surgeon examination is required.
Refugees have special medical rules
A refugee who completed the required overseas examination generally does not automatically repeat the entire medical examination at adjustment.
The current I-693 instructions distinguish cases involving:
- No Class A finding overseas;
- A Class A finding;
- Vaccination compliance;
- Required domestic follow-up; and
- Other special refugee medical procedures.
Pregnancy
Pregnancy does not automatically prevent completion of an immigration medical examination.
The applicant should discuss:
- Pregnancy with the civil surgeon;
- Required testing;
- Vaccinations that may be medically inappropriate during pregnancy;
- Radiographic precautions;
- CDC technical instructions; and
- Any resulting medical notation or blanket waiver.
The civil surgeon determines the medical process under the current technical instructions.
USCIS can request a new or updated medical
Even where a Form I-693 otherwise satisfies the applicable validity rule, USCIS can request additional medical evidence if there is reason to believe the form no longer accurately reflects the applicant's medical condition.
This can arise from:
- New health information;
- Incomplete testing;
- Public-health concerns;
- Errors on the form;
- Changed medical classification; or
- Other evidence in the immigration record.
Example: old I-693 from a denied I-485
An applicant submitted a properly completed Form I-693 with a prior Form I-485. USCIS later denied that adjustment application. The applicant files a new Form I-485 based on another valid basis. Under USCIS's June 2025 validity policy, the prior I-693 generally does not remain valid for the new benefit application merely because it was once properly completed.
Example: positive TB screening test
An applicant has a positive TB screening test. That result alone does not establish a final Class A immigration finding. The civil surgeon must complete the required CDC evaluation, which can include radiographic or laboratory testing, and determine the appropriate immigration classification before the medical record is complete.
Form I-693 checklist
- Confirm whether Form I-693 is required for the category.
- Use a currently designated civil surgeon.
- Use the current Form I-693 edition.
- Bring government photo identification.
- Bring vaccination records.
- Bring relevant prior medical records.
- Complete required TB screening.
- Complete required vaccination assessment.
- Address any Class A finding.
- Determine whether a waiver is available and required.
- Review special K, refugee, or other category rules.
- Submit the required medical with Form I-485 when current rules require concurrent submission.
- Do not open the sealed USCIS envelope where one is provided.
- Keep the applicant copy.
- Do not rely on the superseded indefinite-validity policy.
Common medical-exam mistakes
Using a Regular Doctor
The examination is completed by a physician who is not a designated civil surgeon.
Omitting Required I-693 at Filing
The applicant follows old practice even though current USCIS rules require the medical with Form I-485.
Opening the Envelope
The applicant alters the sealed medical package provided for USCIS submission.
Relying on Indefinite Validity
A medical from a prior denied or withdrawn benefit is reused despite the June 2025 policy change.
Assuming Positive TB Test Means Automatic Denial
The screening result is confused with the final CDC medical classification.
Repeating an Overseas Medical Unnecessarily
A K or refugee applicant obtains a full new exam without checking the category-specific Form I-693 instructions.
Primary authorities
Related INA245.com guides
Frequently asked questions
Do I have to submit Form I-693 with Form I-485?
If you are an applicant required under the current USCIS instructions to submit Form I-693 or a required partial Form I-693, current filing rules generally require that medical documentation with Form I-485.
How long is Form I-693 valid?
Under USCIS's June 11, 2025 policy, a properly completed Form I-693 is generally valid for the immigration benefit application with which it was submitted while that application remains pending.
Can I use the medical from a previously denied I-485?
Generally not under the current policy merely because the earlier medical was valid for the prior case. A new benefit application generally requires a new Form I-693.
Is COVID-19 vaccination required?
No. Effective January 22, 2025, USCIS stopped requiring adjustment applicants to document COVID-19 vaccination.
Does a positive TB test automatically make me inadmissible?
No. The civil surgeon must complete the CDC-required evaluation and determine the final medical classification.
Can my family doctor complete Form I-693?
Only if the physician is a USCIS-designated civil surgeon or qualifies under a specific blanket-designation rule.
The immigration medical is not simply a doctor's physical—it is a statutory inadmissibility examination governed by USCIS and CDC rules.
The Messersmith Law Firm, P.A. represents adjustment applicants in matters involving Form I-693, tuberculosis, medical inadmissibility, vaccination issues, waivers, RFEs, NOIDs, and complex Form I-485 eligibility.
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