I-693 Medical Exam: Your Complete 2026 Guide

If you are applying for a green card from inside the United States, the I-693 medical exam is the step that proves you are not inadmissible on health-related grounds. A USCIS-designated civil surgeon performs it, most people adjusting status must complete it, and it typically costs $200 to $500.

The rules changed in 2024 and 2025: you now file the exam with your green card application, the COVID-19 vaccine is no longer required, and a new form edition is in effect. 

This guide walks you through the process, costs, vaccines, validity rules, and how to choose a civil surgeon.

What is Form I-693?

Form I-693, the Report of Immigration Medical Examination and Vaccination Record, is the USCIS form a designated civil surgeon completes to confirm you meet the health requirements for lawful permanent residence and that no condition makes you inadmissible. Most adjustment of status applicants, those seeking permanent residence through Form I-485, must submit it, and you can download the form and instructions from the USCIS website, though the surgeon fills in most of it. As of July 3, 2025, the agency only accepts the 01/20/2025 edition, so confirm the edition date matches the current version. U.S. citizens do not need it, and some applicants, such as K-1 fiancé entrants already examined abroad, may only need the vaccination record updated.

The exam screens for Class A conditions: CDC-designated communicable diseases of public health significance, such as active tuberculosis, syphilis, or gonorrhea, along with mental disorders involving harmful behavior and drug abuse. A Class A finding can make you inadmissible but is usually treatable, while lesser Class B conditions are noted without barring your green card.

The I-693 medical examination process

Your I-693 medical exam usually happens in one visit with four parts, each handled by the civil surgeon:

1. Medical history and review: The surgeon goes over your records, current medications, and prior conditions.
2. Physical examination: A head-to-toe check and a mental-health screen look for any condition of concern.
3. Lab testing: A TB test (a skin test or blood test) is required for applicants 2 and older, with a chest X-ray if it is positive, per the CDC technical instructions. A blood test for syphilis and a urine test for gonorrhea are required by age, and your surgeon may order additional tests if results warrant.
4. Vaccinations: The surgeon reviews your records and administers any required vaccines you still need.

This is a screening exam, not treatment: the surgeon checks only for the grounds of inadmissibility.

What to bring to your appointment

Bring everything your civil surgeon needs so you avoid paying for repeat tests or vaccines:

• Photo identification: a government-issued ID, such as a passport or driver’s license, that shows your full name.
• Vaccination history: your complete vaccination record and any immunization, health care, or medical records.
• Medical details: a list of current medications and details of any past conditions.
• Payment and glasses: the exam fee, plus your eyeglasses if you wear them.

I-693 vaccination requirements and records

Your I-693 vaccination requirements follow the CDC immunization schedule for immigration and the Advisory Committee on Immunization Practices (ACIP) recommendations, set out in the CDC technical instructions for civil surgeons. Common vaccines include MMR (measles, mumps, and rubella), Tdap, polio, varicella, hepatitis B, and seasonal influenza, based on your age and history.

Two recent changes matter: a polio (IPV) requirement was added to the technical instructions in May 2024, and the COVID-19 vaccine is no longer required as of January 2025. Bring your vaccination records so the surgeon can credit doses you already have.

If a vaccine is medically inappropriate or conflicts with your religious beliefs, you may qualify for a waiver. It’s either a blanket waiver or an individual waiver that the agency must approve.

Who can perform your I-693 exam?

In the United States, only a USCIS-designated civil surgeon can complete your Form I-693, following the CDC technical instructions. You can find one through the USCIS civil surgeon locator. Refugees and asylees can often use a local health department instead.

If you are applying for an immigrant visa from abroad rather than adjusting status, a panel physician—not a civil surgeon—performs your exam, and you will not file Form I-693. Nonimmigrant visa applicants examined overseas follow that separate process.

How long does the I-693 exam take? 

You should plan for more than a single appointment. The first visit usually takes one to two hours for the exam, labs, and vaccines.

A shorter second visit follows once results return, typically within one to two weeks. Your surgeon then gives you the completed Form I-693 in a sealed envelope, and you build that timeline into your filing schedule.

Form I-693 validity and expiration dates

How long your Form I-693 stays valid depends on when the civil surgeon signed it. The I-693 expiration now turns on that signing date and your application’s status.

Under the current policy, effective June 11, 2025, a signed Form I-693 dated on or after November 1, 2023 is tied to a single application—often called the I-693 one application rule. If that application is denied or withdrawn, the form is no longer valid, and you need a new exam before using it for any future immigration benefit.

A USCIS officer can also request a new exam if your medical condition may have changed. An earlier I-693 new policy 2024 update briefly made the form valid indefinitely, but the agency reversed it on public-health grounds.

You can read the details in the USCIS Policy Manual. The shift followed a November 2023 change requiring surgeons to report exam data to the CDC electronically under the technical instructions.

When to submit Form I-693 to USCIS? 

Your timing matters here. Since December 2, 2024, you file the I-693 with I-485 at the same time, so the two go in together. Filing Form I-485 without it can lead the agency to reject the package.

Do not open the sealed envelope. Submit the I-693 sealed envelope exactly as the civil surgeon handed it to you, since an opened form may not be accepted. You can ask for a photocopy for your own records first. Filing the exam this way is part of qualifying for the immigration benefit you are seeking.

What does an I-693 deficiency notice mean?

If your Form I-693 is incomplete or improperly completed, the agency issues a Request for Evidence (RFE), sometimes called a deficiency notice. It means a required field, test, or signature is missing—not a finding on your eligibility.

Take the notice back to your civil surgeon, who can correct or redo the form. Return the corrected, signed Form I-693 by the deadline on the notice.

How to choose your civil surgeon? 

Because not all civil surgeons charge the same or work at the same speed, you should compare a few before booking. Pick your I-693 civil surgeon from the USCIS locator, then weigh price, turnaround, and reviews.

Ask up front what the immigration medical exam costs, whether the office stocks the vaccines you need, and how quickly it returns results. The I-693 cost typically runs $200 to $500, plus any vaccines, separate from USCIS filing fees. Bringing your vaccination records can lower the bill.

Time your I-693 medical exam right the first time

Your I-693 intersects with your Form I-485 timing, your civil surgeon visit, your vaccination records, and the current form edition. Getting it right means scheduling the exam early, bringing the right documentation, keeping the surgeon's envelope sealed, and filing the correct edition alongside your I-485. Mistakes can result in a rejected or expired exam, a Request for Evidence, or weeks of avoidable delay to your green card.

Lighthouse helps applicants navigate these requirements through expert case management and technology built for immigration workflows. Our team coordinates your medical-exam timing with your employment-based EB-2, EB-3, EB-2 NIW, EB-1, or O-1A green card timeline, tracks your pending filings, and confirms your exam is on the right edition and properly sealed before you submit. We provide legal review to ensure your filings meet USCIS standards and keep you informed of any changes that could affect your timing.

Start your green card evaluation today.

Frequently asked questions on the I-693 medical exam

These FAQs answer what you are most likely to ask before your appointment. This guide is general information, not legal advice. An immigration attorney can advise on your specific case.

What is the I-693 form for? 

Form I-693 reports the results of your immigration medical examination to the agency, proving you are not inadmissible on health grounds. It is required for most green card applicants who adjust status inside the United States.

How much is the I-693 exam? 

The exam typically costs $200 to $500, depending on the surgeon and location, plus any vaccines you still need. There is no separate USCIS fee for the form itself.

What is the new rule for green card applicants? 

The key 2025 change is that an I-693 signed on or after November 1, 2023 is valid only for the application you file it with. If that application is denied or withdrawn, you need a new exam for any future filing.

How long does it take to get the I-693? 

Most surgeons finish within one to two weeks across two visits: the exam and labs first, then a short follow-up to collect your sealed Form I-693 once results are in.

Why is the I-693 immigration physical? 

It is a standardized exam, covering medical history, physical examination, TB and other lab tests (including a chest X-ray when indicated), and a vaccination review, performed by a designated civil surgeon to screen for health-related grounds of inadmissibility.

Why is the I-693 required? 

U.S. immigration law bars admission for certain Class A conditions, including communicable diseases and missing vaccinations. Form I-693 documents that you do not fall under those grounds.

What happens after the examination? 

The surgeon seals your completed Form I-693 in an envelope, which you file with your Form I-485. The agency reviews it alongside your case and issues a deficiency notice if anything is missing.