Green Card Medical Exam (Form I-693): What to Expect in 2026

Every green card applicant who files through adjustment of status must complete an immigration medical examination. A USCIS-designated civil surgeon performs the exam, completes Form I-693, and seals it for submission with your I-485 application. No I-693, no green card — there are no exceptions.

This guide covers who needs the exam, what happens during it, the vaccination requirements, costs, timing rules, and the critical filing changes that took effect in late 2024.

Who needs the medical exam?

Every applicant filing Form I-485 (Adjustment of Status) must submit a completed Form I-693, regardless of category:

• Marriage-based green card applicants
• Family-based applicants (parents, siblings, children)
• Employment-based applicants (EB-1, EB-2, EB-3, EB-5)
• Diversity visa lottery winners adjusting status
• Asylum and refugee adjustments
• VAWA, U-visa, and T-visa applicants

Children under 15 still need the exam but may have fewer vaccination requirements based on the CDC immunization schedule.

Finding a civil surgeon

You cannot use your regular doctor. The exam must be performed by a USCIS-designated civil surgeon — a licensed U.S. physician authorized by USCIS to conduct immigration medical exams.

To find one near you:

1. Go to the USCIS Civil Surgeon Locator on USCIS.gov
2. Enter your zip code
3. Call ahead to confirm the doctor is accepting new immigration patients and ask about fees

Prices vary widely — from $200 in smaller cities to $500+ in major metros. Always ask for the total cost including vaccinations before booking.

What happens during the exam

The medical exam typically takes 30–60 minutes and includes:

Physical examination

• Height, weight, and vital signs
• Eyes, ears, nose, and throat
• Heart and lungs
• Abdomen and extremities
• Skin (checking for signs of communicable diseases)
• Mental health screening (basic assessment)

Required lab tests

• Tuberculosis: Interferon-Gamma Release Assay (IGRA) blood test, or tuberculin skin test (TST). If positive, a chest X-ray is required
• Syphilis: Blood test (required for applicants 15 and older)
• Gonorrhea: Urine or swab test (required for applicants 15 and older)
• HIV: Blood test (required for applicants 15 and older)

Required vaccinations (2026 list)

USCIS requires all age-appropriate vaccinations from the CDC schedule:

COVID-19 is no longer required as of 2023.

If you have prior vaccination records, bring them. The civil surgeon can accept documented proof of prior immunizations and will not repeat shots unnecessarily.

Timing: when to get the exam

The new concurrent filing rule

Since December 2, 2024, USCIS requires Form I-693 to be submitted at the same time as your Form I-485. You can no longer file I-485 first and submit the medical exam later.

This means you need to complete the exam before filing your green card application.

Form I-693 validity

• If submitted within 60 days of the civil surgeon’s signature: valid for 2 years from the signature date
• If submitted after 60 days: valid for 2 years from the date USCIS receives it

Practical timing strategy

Schedule your medical exam 2–4 weeks before you plan to file I-485. This gives you time to:

1. Complete any missing vaccinations (some require two doses weeks apart)
2. Wait for lab results (TB blood test takes 2–3 days)
3. Receive the sealed Form I-693 envelope
4. File everything together

What the civil surgeon gives you

After the exam, the civil surgeon will:

1. Complete Form I-693
2. Place it in a sealed envelope with their signature across the seal
3. Give you the sealed envelope to include with your I-485 package

Do not open the envelope. If the seal is broken, USCIS will reject the form and you will need to repeat the exam.

One exam per application

As of November 2023, a Form I-693 signed on or after that date is only valid for the specific I-485 application it was submitted with. If your I-485 is denied or withdrawn, you cannot reuse that I-693 for a future filing — you need a new exam.

Health-related inadmissibility

USCIS may find you inadmissible on health grounds if the I-693 reveals:

• Class A conditions: Active, communicable tuberculosis; untreated syphilis or gonorrhea; substance abuse disorders (with associated harmful behavior). These are grounds for denial, though waivers are available through Form I-601.
• Class B conditions: Physical or mental conditions that are significant but not currently dangerous. These are noted on the form but do not block your green card.

Having a chronic condition like diabetes, hypertension, or a disability does not make you inadmissible. USCIS is looking for communicable diseases and substance abuse disorders specifically.

Vaccination waivers

If you cannot receive a required vaccine due to medical reasons or religious or moral convictions, you can request a waiver:

• Medical waiver: Your civil surgeon documents the medical contraindication on the I-693
• Religious/moral waiver: File a written statement with your I-485 explaining your sincere religious or moral opposition to vaccination, along with supporting documentation

Waivers are evaluated on a case-by-case basis and are not guaranteed.

Costs breakdown

Insurance rarely covers immigration medical exams. Some civil surgeons offer package pricing that includes common vaccinations.

Tips to avoid delays

1. Bring vaccination records — any official records from childhood or abroad
2. Bring a government-issued photo ID (passport, driver’s license)
3. Bring your I-485 receipt if you have one (though with concurrent filing, you may not)
4. Ask about package pricing when you call to schedule
5. Do not open the sealed envelope — ever
6. Schedule early — some civil surgeons are booked 2–3 weeks out