Form I-693 Guide · Updated May 2026
Green Card Medical Exam (Form I-693): What You Need to Know
A plain-English guide to the immigration medical exam every I-485 applicant must complete.
Summary
Every green card applicant filing Form I-485 (Application to Register Permanent Residence, the green card application filed from inside the U.S.) must pass a medical exam done by a USCIS-designated doctor called a civil surgeon. The results go on Form I-693, which you submit with your I-485 at initial filing. The exam covers a physical, vaccination review, and disease screenings. As of May 2026, it typically costs $200 to $500, paid directly to the civil surgeon. As of June 2025, the form is valid only for the specific application it is filed with.
At a glance
| Who needs it | All applicants filing Form I-485 (Application to Register Permanent Residence, the green card application filed from inside the U.S.) |
| Who does the exam | A USCIS-designated civil surgeon (your regular doctor cannot do it, even if they are a licensed physician) |
| Find a civil surgeon | USCIS civil surgeon locator at uscis.gov/tools/find-a-civil-surgeon (search by zip code or city) |
| Cost | $200 to $500 for the exam, paid directly to the civil surgeon (not a USCIS fee). Add $50 to $200 per vaccine series you are missing |
| When to submit | With your I-485 at initial filing. Required since December 2, 2024. Must be submitted within 60 days of the civil surgeon's signature date |
| Validity (June 2025 update) | Valid only for the specific I-485 application it was submitted with. If your I-485 is denied or withdrawn and you refile, you need a new exam |
| Sealed envelope | The civil surgeon seals the completed form in a signed envelope. Do not open it. USCIS rejects unsealed forms |
| COVID-19 vaccine | No longer required for AOS applicants (waived January 22, 2025). All other vaccine requirements still apply |
Figures are current as of May 2026. Verify current rules at uscis.gov/i-693 before filing.
What the medical exam is, in plain English
When you apply for a green card from inside the United States, USCIS needs to confirm you do not have certain health conditions that would make you inadmissible (the legal term for “not allowed in”). The immigration medical exam is how USCIS checks that.
The exam is done by a USCIS-designated physician called a civil surgeon. The civil surgeon is not a USCIS employee. Civil surgeons are regular doctors who have been certified by USCIS specifically to perform the green card medical exam. Your personal doctor cannot fill out Form I-693, no matter how long you have been their patient. You have to use someone from the official USCIS list.
After the exam, the civil surgeon fills out Form I-693 (Report of Immigration Medical Examination and Vaccination Record), signs it, and seals it in an envelope. You include that sealed envelope in your I-485 filing packet. Do not open the envelope. USCIS rejects a form that arrives unsealed.
The official USCIS page for this form is at uscis.gov/i-693. The USCIS Policy Manual covers the health-related review in Volume 8, Part B.
Who needs Form I-693
Anyone filing Form I-485 (the green card application filed from inside the U.S.) needs a completed I-693. That covers the spouse of a U.S. citizen going through Adjustment of Status (AOS), as well as most other green card categories that use the I-485.
If the immigrant spouse is currently outside the U.S. and going through Consular Processing (a visa interview at a U.S. embassy abroad), a similar exam is done by a panel physician abroad. That process uses forms specific to consular cases, not Form I-693. This guide covers I-693 for I-485 filers only. For the consular path, see the Consular Processing guide.
A few other situations worth knowing:
- Conditional green card holders filing Form I-751 (the form to remove conditions on a two-year green card) do not need a new I-693 unless USCIS requests one.
- Children under 15 do not need syphilis serology, but they still need the physical exam and vaccination review.
- If your first I-485 was denied or withdrawn and you refile, you need a new I-693. The June 2025 USCIS policy update made the form application-specific.
- If USCIS returned (rejected) your unopened application package before accepting it, you can resubmit the same I-693 with the corrected package.
Finding a civil surgeon
USCIS publishes a searchable list of designated civil surgeons at uscis.gov/tools/find-a-civil-surgeon. Enter your zip code or city to find certified doctors near you. Not every doctor who advertises “green card physicals” online is actually USCIS-designated. Always start with the official USCIS locator.
Call ahead to confirm the doctor still performs I-693 exams. Civil surgeons can drop from the USCIS list, and the directory does not always update instantly.
Ask whether blood tests and vaccines are done in-office or sent to an outside lab. Some offices return the sealed form the same day; others take 3 to 7 business days.
Compare prices. USCIS does not set fees, so costs vary widely by region. A quick phone comparison can save $100 or more.
The Process
What the exam includes
The immigration medical exam has four main parts. The whole visit typically takes 30 minutes to an hour.
Physical examination
A standard physical: vital signs, heart and lungs, abdomen, skin, eyes, ears, and other systems. The civil surgeon is looking for physical conditions relevant to the health-grounds inadmissibility rules under U.S. immigration law.
Mental health screening
A general mental health assessment done through interview and observation. This is not a lengthy psychological evaluation.
Disease testing
Tuberculosis (TB) screening using an IGRA blood test (QuantiFERON-Gold or T-SPOT) for all applicants age 2 and older. Syphilis serology for applicants 18 and older. Gonorrhea testing at applicable ages per CDC guidelines. A chest X-ray is required if the TB test is positive, if TB symptoms are present, or if the applicant has known HIV infection. HIV testing itself is no longer part of the standard immigration medical exam (removed from the inadmissibility list in 2009).
Vaccination review and updates
The civil surgeon checks your vaccination history against the CDC's required schedule for immigrants. If you are missing required vaccines, the civil surgeon administers them during the visit at additional cost. Bring documentation of any prior vaccinations to reduce the chance of repeat doses.
Required vaccines as of May 2026
The civil surgeon checks your vaccination records against the CDC's required schedule for immigrants. Missing vaccines are given at the appointment (at extra cost). Bring whatever documentation you have to reduce repeat doses.
| Vaccine | Doses required |
|---|---|
| MMR (measles, mumps, rubella) | 2 doses |
| Varicella (chickenpox) | 2 doses, or documented prior illness |
| Hepatitis A | 2 doses |
| Hepatitis B | 3-dose series |
| Tdap (tetanus, diphtheria, pertussis) | 1 Tdap dose, then Td boosters |
| Influenza (seasonal) | 1 annual dose |
| Meningococcal | Per age-group guidelines |
| COVID-19 | Not required for AOS applicants as of January 22, 2025 |
Sources: USCIS Vaccination Requirements and CDC Technical Instructions for Civil Surgeons.
Vaccine exemptions
USCIS may grant an exemption from vaccination requirements if compliance would be contrary to a sincerely held religious belief or moral conviction (not just a preference) that is consistently applied in the applicant's life. Medical contraindications are also a basis for exemption. See USCIS Policy Manual Volume 9, Part D, Chapter 3.
How much the exam costs
USCIS does not regulate civil surgeon fees. Each provider sets their own price, and costs vary widely by region. The exam fee is paid directly to the civil surgeon; USCIS does not charge a separate filing fee for Form I-693 itself.
| Cost bucket | Typical range (May 2026) |
|---|---|
| Exam visit fee | $150 to $350 |
| Required lab tests (TB, syphilis, etc.) | Sometimes included; sometimes billed separately ($50 to $150) |
| Vaccines you are missing | $50 to $200+ per vaccine series |
| Total out of pocket | $200 to $500+ (more if many vaccines are needed) |
The I-693 medical exam cost is in addition to all USCIS filing fees. For the full USCIS fee breakdown, see the Adjustment of Status guide.
Validity rules: what changed in 2024 and 2025
The rules around I-693 validity have changed multiple times in recent years. Here is the current state as of May 2026, sourced to USCIS policy.
December 2, 2024
I-693 must be submitted with the I-485 at filing
USCIS began requiring Form I-693 to be submitted with the initial I-485 filing. Before this date, some applicants waited and brought the medical exam to their interview. That option is closed for most applicants. If you file your I-485 without the I-693 when one is required, USCIS can reject the application. Source: USCIS alert "USCIS Now Requires Report of Immigration Medical Examination and Vaccination Record to be Submitted with Form I-485 for Certain Applicants" (uscis.gov).
June 11, 2025
I-693 is now tied to the specific application it was filed with
USCIS updated its Policy Manual to state that an I-693 is only valid for the specific immigration benefit application it was submitted with. If your I-485 is denied or you withdraw it and refile, you need a new medical exam. The previous policy (from April 2024) had said the form stayed valid indefinitely. USCIS reversed that because it created public health concerns. Source: USCIS Policy Manual update June 11, 2025.
Ongoing: 60-day submission window
The I-693 must reach USCIS within 60 days of the civil surgeon's signature
There is a 60-day window between the date the civil surgeon signs the form and when it must reach USCIS. If you get the exam done but delay filing by more than 60 days, you may need a new exam. Schedule the appointment close to your planned filing date.
Exception
Rejected (returned) applications can reuse the same I-693
If USCIS rejects and returns your application package unopened before accepting it, this is a rejection before filing acceptance, not a denial after review. You can resubmit the same I-693 with the corrected package.
Tuberculosis screening: what each result means
TB is the health condition that comes up most often in immigration medical exams, both because it is tested specifically and because the follow-up steps can add time to the process. The civil surgeon uses an IGRA blood test (QuantiFERON-Gold or T-SPOT), which replaced the old skin-prick test for immigration purposes.
| Result | What it means | Effect on your case |
|---|---|---|
| Negative | No TB exposure detected | No action needed. Exam proceeds normally |
| Positive, no active disease (latent TB) | Past exposure to TB bacteria, but no current illness | Chest X-ray ordered. If clear, case proceeds normally. Latent TB does not make you inadmissible |
| Active TB (Class A) | Communicable tuberculosis requiring treatment | Civil surgeon cannot finalize the I-693 until treatment completes (about 6 months). A waiver is theoretically available but rarely granted for infectious TB |
Source: USCIS Policy Manual Volume 8, Part B, Chapter 6 and CDC Tuberculosis Technical Instructions for Civil Surgeons.
What the results mean: Class A and Class B conditions
After the exam, the civil surgeon classifies any findings. The classification matters because USCIS uses it to decide whether a condition makes someone inadmissible.
Class A conditions (bar to admission)
Class A conditions make an applicant inadmissible under U.S. immigration law. Examples: communicable disease of public health significance (active infectious TB is the most common), physical or mental disorder with associated harmful behavior, and substance abuse. A Class A finding does not automatically end the application. Waivers of inadmissibility are available for some conditions through Form I-601, but the waiver process is a separate step.
Class B conditions (noted but not a bar)
Class B conditions are physical or mental abnormalities, diseases, or disabilities that are not Class A. They appear on the I-693 but do not make someone inadmissible on their own. USCIS or the interviewing officer may note the condition and occasionally ask follow-up questions, but a Class B finding alone does not block a green card.
No finding
The civil surgeon certifies the applicant as medically admissible. The I-693 is sealed and included in the I-485 filing packet with no special action required.
When to schedule the exam
Schedule the exam too early and you may run past the 60-day submission window before you are ready to file. Schedule it too late and you might need vaccines that take weeks to complete.
Common issues and how to handle them
A few situations come up often enough to address directly.
"My regular doctor offered to do the exam."
Your regular doctor cannot complete Form I-693 unless they are specifically designated by USCIS as a civil surgeon. Use the USCIS civil surgeon locator to verify before booking.
"I got a positive TB test."
A positive IGRA result triggers a chest X-ray. If the X-ray is clear (and it usually is for people who feel healthy), your case proceeds normally. Latent TB does not block a green card. If the X-ray shows active disease, talk to an immigration attorney.
"I'm missing several vaccines, including some that need multiple doses."
Ask the civil surgeon what happens for multi-dose series. USCIS allows a partial I-693 for some series with a note that it is in progress. Budget extra time and cost if your vaccination records are incomplete.
"I have a Class B condition on my exam."
A Class B finding does not make you inadmissible. It appears in the I-693 as a noted condition but will not, on its own, prevent your green card. USCIS or the interviewing officer may ask follow-up questions.
"I opened the sealed envelope by accident."
Contact the civil surgeon. They will need to re-seal it or reissue the form. USCIS rejects a form that arrives with a broken seal.
"My case was filed before December 2024 and I was told to bring the I-693 to my interview."
If your case was filed before December 2, 2024, the older guidance may still apply. For any I-485 filed after that date, the I-693 must be in the initial filing packet. If you are not sure what applies to a pending case, consult an immigration attorney.
Do you need a lawyer?
Most straightforward I-485 cases do not require an attorney to handle the medical exam. The civil surgeon handles the medical side, and the I-693 is one document in a larger filing packet. Self-help software can handle the rest of the packet mechanics.
Hire an attorney when the case has real complexity: a Class A condition, a history of TB or another communicable disease, a prior waiver of inadmissibility, or any situation where USCIS may request additional documentation about a health issue.
How Green Card Genius fits
Green Card Genius is self-help immigration software built for marriage-based green card cases. The software walks couples through all the required forms, including Form I-485, using plain-English questions and prepares the full packet for review and submission. The I-693 must be done with a licensed civil surgeon in person; that part is not something software can replicate. But Green Card Genius guides you to the USCIS civil surgeon locator and makes sure the rest of your I-485 packet is complete and ready to file alongside the sealed envelope. The one-time fee is $99 (a fraction of typical attorney fees of $2,000 to $5,000). The Denial Protection Guarantee returns the $99 service fee if USCIS denies the application for any reason. Government filing fees paid directly to USCIS are separate.
Green Card Genius is not a law firm and does not provide legal advice.
Frequently asked questions
Do I need a medical exam for a marriage green card?
Yes, if you are filing Form I-485 (Application to Register Permanent Residence, the green card application filed from inside the U.S.). The medical exam is documented on Form I-693 and is required for all I-485 applicants. Since December 2, 2024, you must submit it with your I-485 at initial filing.
Can my regular doctor do the green card medical exam?
No. Only a USCIS-designated civil surgeon can complete Form I-693. Your regular doctor, specialist, or urgent care provider cannot do it, even if they are licensed physicians. Use the USCIS civil surgeon locator at uscis.gov/tools/find-a-civil-surgeon to find a certified doctor near you.
How much does the green card medical exam cost?
The exam typically costs $200 to $500, paid directly to the civil surgeon. USCIS does not regulate what civil surgeons charge, so prices vary by location. Add costs for any vaccines you are missing. Each series can run $50 to $200 more.
What does the green card medical exam test for?
The exam includes a physical examination, mental health screening, tuberculosis (TB) screening using an IGRA blood test, and a vaccination review. Syphilis testing is required for applicants 18 and older. HIV testing is no longer part of the standard immigration medical exam. A chest X-ray is required if the TB test is positive or if TB symptoms are present.
When should I schedule the green card medical exam?
Schedule it shortly before you plan to file your I-485. USCIS requires the I-693 to be submitted within 60 days of the civil surgeon's signature date. Most applicants schedule the exam 2 to 4 weeks before their planned filing date.
How long is Form I-693 valid?
As of June 11, 2025, Form I-693 is valid only for the specific I-485 application it was submitted with. If your I-485 is denied or withdrawn and you refile, you need a new medical exam. The form must also be submitted to USCIS within 60 days of the civil surgeon's signature date.
Is the COVID-19 vaccine required for the green card medical exam?
No. USCIS waived the COVID-19 vaccine requirement for Adjustment of Status applicants effective January 22, 2025. The CDC also removed the COVID-19 vaccine from the required list for consular processing applicants effective March 11, 2025. All other vaccine requirements still apply.
What if I have a positive TB test?
A positive IGRA (TB blood test) does not automatically block your green card. The civil surgeon orders a chest X-ray. If the X-ray shows no active disease, your case proceeds normally. Latent TB (past exposure without active illness) does not make you inadmissible. Active infectious TB is a Class A condition that blocks the application until treatment is finished.
Can a green card be denied because of the medical exam?
A Class A medical condition, such as active communicable tuberculosis, can make an applicant inadmissible and block the green card unless a waiver is granted. Class B conditions do not make someone inadmissible. Missing vaccines do not block the application; the civil surgeon administers them during the visit. Most applicants pass the medical exam without any issues.
Do I need a new medical exam for my I-751 (removing conditions on a conditional green card)?
No. Applicants filing Form I-751, the form to remove conditions on a two-year conditional green card, do not need to submit a new Form I-693 unless USCIS specifically requests one.
Key takeaways
- ✓
All green card applicants filing Form I-485 must complete a medical exam (Form I-693) with a USCIS-designated civil surgeon. Your regular doctor cannot do it.
- ✓
Since December 2, 2024, you must submit the I-693 with your I-485 at initial filing; waiting to bring it to the interview is no longer an option for most applicants.
- ✓
As of June 11, 2025, Form I-693 is valid only for the specific application it was submitted with. A new exam is required if you refile after a denial or withdrawal.
- ✓
The I-693 must be submitted to USCIS within 60 days of the civil surgeon's signature date. Schedule the exam close to your planned filing date.
- ✓
The exam costs $200 to $500, paid directly to the civil surgeon (not a USCIS fee), with additional costs for any missing vaccines.
- ✓
The COVID-19 vaccine is no longer required for AOS applicants (waived January 22, 2025). All other vaccine requirements still apply.
- ✓
A positive TB blood test does not automatically block your application. A chest X-ray follows, and latent TB is not a bar to a green card.
This article 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. Information is current as of May 2026; verify any fee, processing time, or eligibility rule against the relevant USCIS page before relying on it.
Be a Genius
Only pay when you file