When to Submit Form I-693: Medical Exam Timing & Validity (2026)

When the I-693 immigration medical exam has to reach USCIS, and how long a signed exam stays valid, for a marriage-based green card filed from inside the U.S.

Quick answer

Get the civil surgeon exam done before you mail your green card packet, and submit Form I-693 together with Form I-485. An I-693 signed on or after November 1, 2023 stays valid for as long as the I-485 it was filed with is pending. Under a USCIS policy update effective June 11, 2025, the exam is tied to that specific application: if that I-485 is withdrawn or denied, the I-693 is no longer valid and a new exam is required for any future filing. Confirm the current rule on uscis.gov.

Summary

For a marriage-based adjustment of status (the process of applying for a green card from inside the United States, abbreviated AOS), USCIS expects Form I-693, the immigration medical exam report, to arrive with your Form I-485. The I-485 Instructions say plainly that if you are required to submit a Form I-693 you must submit it with your I-485, or the I-485 may be rejected. That is why most filers book the civil surgeon (a doctor USCIS has authorized to perform the immigration exam) before they mail the packet. On validity: the I-693 Instructions still print a two-year shelf life, but USCIS policy changed that. Any I-693 a civil surgeon signs on or after November 1, 2023 is valid for as long as the associated I-485 is pending. Under a USCIS policy update effective June 11, 2025, that validity is tied to the specific application the exam was filed with: if that I-485 is withdrawn or denied, the I-693 is no longer valid and a new exam is required for any future filing. This page is about the timing and the validity window only, not about which vaccinations or medical findings are required.

When to submit it	With your Form I-485. The I-485 Instructions (page 13) say a required I-693 must be submitted with the I-485, or the I-485 may be rejected.
When to do the exam	Before you mail the packet, so the sealed I-693 envelope can go in the same package as the I-485.
Validity (signed on/after Nov 1, 2023)	Valid for as long as the I-485 it was filed with is pending. Under a USCIS policy update effective June 11, 2025, it is tied to that specific application: if the I-485 is withdrawn or denied, the I-693 is no longer valid and a new exam is required.
The old two-year rule	The I-693 Instructions still print a two-year window from the signature date. USCIS policy removed the fixed expiration for exams signed on/after Nov 1, 2023.
Sealed envelope	The civil surgeon gives you the completed form in a sealed envelope. Submit it unopened; USCIS returns it if the seal is broken.

Who this page is for

This page covers the timing of when to submit Form I-693 and how long a signed exam stays valid, for someone filing a marriage-based adjustment of status (a green card application made from inside the United States). It does not cover which vaccinations apply or any medical finding. If the civil surgeon notes a medical condition, a waiver, or a physical or mental disorder, those are decided by the doctor and, where a waiver is involved, are a matter for a licensed immigration attorney.

What the form and instructions say about timing

Form I-693 is the Report of Immigration Medical Examination and Vaccination Record. Part 1 is your information; the timing rules live in the filing steps and in the I-485 Instructions.

Form I-693, Part 1 (Information About You) header and title block as it appears on edition 01/20/25 — Form I-693, Part 1. Edition 01/20/25. Source: USCIS.

The clearest statement on when to submit it is in the I-485 Instructions:

Verbatim · Form I-485 Instructions, edition 01/20/25, page 13
“If you are required to submit a Form I-693, or a partial Form I-693 (such as the Vaccination Record), you must submit it with your Form I-485. Otherwise, your Form I-485 may be rejected.”

The I-693 Instructions add the validity line in filing step 6:

Verbatim · Form I-693 Instructions, edition 01/20/25, page 1, step 6
“Submit your completed Form I-693 in the sealed envelope to USCIS. Form I-693 remains valid for two years from the date of the civil surgeon's signature.”

The two-year line printed in the I-693 Instructions is superseded by current USCIS policy for exams signed on or after November 1, 2023 (covered below). Always complete the current edition from uscis.gov/i-693; USCIS rejects outdated editions.

Where the medical exam fits in a concurrent green card packet

Four steps, in order. The exam comes before you mail, so the sealed I-693 envelope can travel in the same package as your I-485.

1
Find a USCIS-designated civil surgeon
Use the Find a Doctor tool on uscis.gov to locate a civil surgeon (the doctor USCIS authorizes to perform the immigration exam). Book the appointment early, because exam availability and any follow-up tests can take a few weeks.
2
Attend the exam and any follow-ups
Bring your vaccination records and a government photo ID. Do not sign Part 1 of the form ahead of time; you sign in front of the civil surgeon. Complete any required follow-up before the form can be certified.
3
Get the sealed envelope
The civil surgeon completes and signs the form, then gives it to you in a sealed envelope marked for USCIS only. Keep it sealed. USCIS returns the form if the envelope is opened or altered, which costs you time.
4
Mail the I-693 with the I-485 packet
Place the sealed I-693 envelope in the same package as your I-485 (and, for a concurrent marriage filing, alongside the I-130 petition and the I-864 affidavit of support). The I-485 Instructions direct that a required I-693 go in with the I-485.

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Our software builds the I-485, I-130, and I-864 together and tells you exactly where the sealed I-693 envelope goes, so the medical lines up with the rest of the packet.

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How long a signed I-693 stays valid

There are two timing pieces, and they answer different questions. The first is when the form has to reach USCIS: with your I-485. The second is how long the signed exam keeps counting once USCIS has it. The form's own Instructions still print a two-year window from the civil surgeon's signature date. USCIS policy changed that for newer exams: an I-693 the civil surgeon signs on or after November 1, 2023 stays valid for as long as the I-485 it was filed with is pending. So if your case takes longer than two years to adjudicate, a qualifying I-693 does not go stale while your I-485 is still in the queue. There is an important caveat. Under a USCIS policy update effective June 11, 2025, that validity is tied to the specific application the exam was filed with: if that I-485 is withdrawn or denied, the I-693 is no longer valid, and a newly completed exam is required for any future filing. Because the printed Instructions and the current USCIS policy say different things, always confirm the current rule on uscis.gov rather than relying on the two-year line printed inside the form.

What USCIS does with the timing

USCIS uses Form I-693 to decide whether you are inadmissible on health-related grounds under INA section 212(a)(1). Tying the form's submission to the I-485 lets the officer review your medical results in the same window they review the rest of your adjustment application, which is why a missing I-693 can get an I-485 rejected at intake. Removing the fixed two-year expiration for newer exams means USCIS does not have to ask a long-pending applicant to repeat the exam just because the case sat in processing, which cuts down on duplicate exams and Requests for Evidence (an RFE, a USCIS notice asking for more information).

Common mistakes

These are the ones that show up most often around I-693 timing.

1
Mailing the I-485 first and the I-693 later
The I-485 Instructions direct that a required I-693 go in with the I-485. Mailing the packet without it can get the I-485 rejected at intake, costing you weeks. Schedule the exam so the sealed envelope is ready before you mail.
2
Opening the sealed envelope to check it
The civil surgeon hands you the completed form in a sealed envelope marked for USCIS. If you open it, USCIS will not accept it and returns it to you. Keep the copy the civil surgeon gives you for your own records and leave the official envelope sealed.
3
Relying on the printed two-year expiration
The two-year line is still printed inside the I-693 Instructions, but USCIS policy removed the fixed expiration for exams signed on or after November 1, 2023. Those stay valid while the I-485 is pending. Going by the printed text alone can lead you to repeat an exam you did not need to repeat.
4
Signing Part 1 before the appointment
You fill out Part 1 with your information, but you do not sign it until the civil surgeon tells you to, in their presence. Signing early can invalidate the form.

Related guides

Form and pathway context

Frequently asked questions

Do I have to file Form I-693 at the same time as Form I-485?

For a marriage-based adjustment of status, that is what USCIS expects. The I-485 Instructions (edition 01/20/25, page 13) state that a required Form I-693, or a partial one such as the Vaccination Record, must be submitted with your Form I-485, or the I-485 may be rejected. Most filers schedule the civil surgeon exam before they mail the packet for this reason.

How long is a signed Form I-693 valid?

An I-693 signed on or after November 1, 2023 stays valid for as long as the Form I-485 it was filed with is pending. Under a USCIS policy update effective June 11, 2025, the exam is tied to that specific application: if that I-485 is withdrawn or denied, the I-693 is no longer valid and a new exam is required for any future filing. The form's own Instructions still print an older two-year window from the signature date, so confirm the current rule on uscis.gov.

What is a civil surgeon and where do I find one?

A civil surgeon is a doctor USCIS has authorized to perform the immigration medical exam. You find one with the Find a Doctor tool on uscis.gov. Book early, because appointment slots and any follow-up testing can take a few weeks before the form is ready to mail.

Can I open the sealed I-693 envelope?

No. The civil surgeon gives you the completed form in a sealed envelope. USCIS will not accept it if the envelope is opened or altered, and will return it to you. Submit it sealed. The civil surgeon also gives you a copy for your own records.

Where does the medical exam fit in a concurrent marriage green card packet?

The sealed I-693 envelope goes in the same package as the I-485, alongside the I-130 petition and the I-864 affidavit of support for a concurrent marriage filing. Do the exam before mailing so the form is ready when the rest of the packet is.

Does this page tell me which vaccinations I need?

No. This page covers only the timing of when to submit Form I-693 and how long a signed exam stays valid. Which vaccinations and which medical findings apply are decided by the civil surgeon and are covered in the general I-693 medical exam guide.

Key takeaways

✓
Submit Form I-693 with your Form I-485; the I-485 Instructions say a required I-693 must go in with the I-485, or the I-485 may be rejected.
✓
Do the civil surgeon exam before mailing the packet so the sealed I-693 envelope is ready to include.
✓
An I-693 signed on or after November 1, 2023 stays valid for as long as the I-485 it was filed with is pending; under a USCIS policy update effective June 11, 2025, if that I-485 is withdrawn or denied, the I-693 is no longer valid and a new exam is required for any future filing.
✓
The two-year window still printed in the I-693 Instructions is superseded by current USCIS policy for newer exams; confirm on uscis.gov.
✓
Keep the official envelope sealed; USCIS returns an opened or altered I-693.

This page is for educational purposes only and is not legal advice. Green Card Genius is self-help immigration software, not a law firm, and does not provide legal representation. Immigration law and USCIS policy change frequently. For advice on a specific case, consult a licensed immigration attorney. Form I-693, edition 01/20/25. Last verified May 2026.

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