What is the Immigration Medical Exam?
An immigration medical exam is an essential part of the immigration process and is required if you wish to move to the U.S., or if you wish to become a green card holder if you are already in the country. It is especially part of the process of obtaining a green card and for other visa applications. A government-authorized doctor will perform the medical exam. These doctors are vetted by immigration authorities and their exam is only for immigration purposes. The exam normally consists of:
- A general mental and physical examination
- A review of your medical history and immunization or vaccine records
- Drug and alcohol screening
- Testing for various illnesses and diseases
The immigration medical exam is not a comprehensive physical examination and should not be relied on as a substitute for health-related concerns. Even if the doctor discovers health issues, they are not mandated to provide treatment or diagnosis. The sole purpose of the exam is to survey health conditions that are significant to U.S. immigration laws and to make sure your entry or residence in the U.S. will not affect others primarily.
Who is Required to Take an Immigration Medical Exam
The following demographics are required to undergo an immigration physical exam:
- Immigrants — in which their medical exam will be conducted in their country of residence by a panel physician.
- Refugees — in which their medical exam will be conducted in their country of residence by a panel physician.
- Those adjusting their status — in which their medical exam will be conducted in the U.S. by a civil surgeon.
Non-immigrants, short-term transit visa holders, and other types of residents are not required to undergo a medical exam.
Why Take an Immigration Medical Exam?
U.S. Citizenship and Immigration Services (USCIS) needs to ensure all foreign nationals who enter the United States do not pose a threat to the public health of the U.S. population. Certain health conditions or something in your health history could make you inadmissible to the U.S. and render you ineligible for permanent residency. This is called “medical inadmissibility,” or health-related reasons for denial. The four main health conditions that may prevent someone from passing a medical exam include:
- An infectious disease that could affect public health
- Failure to show a complete vaccination record
- A physical or mental disorder associated with harmful behavior
- Alcohol abuse or drug addiction
Avoiding Medical Inadmissibility
You will not be denied permanent residence if you have a cold, or a disease that is chronic but well-managed (such as diabetes). You will not be denied if you had an infectious disease in the past that has been cured. Here are some tips to prevent medical inadmissibility:
- If you previously had a contagious disease (including gonorrhea, syphilis, leprosy, or tuberculosis), you are required to show proof of treatment to USCIS. For proof, bring copies of medical records that show treatment and testing results, along with a statement from your physician confirming that your disease is either cured or well-managed.
- If you have other serious diseases, provide a statement from your doctor that explains how you manage your condition and how much the disease impacts your life, including your ability to work.
- If you have a history of drug abuse, provide proof that you have received treatment.
- If you have a history of mental illness, provide proof that your mental health is well-managed.
If your application is denied for health-related reasons, you can file an I-601 (“Application for Waiver of Grounds of Inadmissibility”) or a government waiver to allow you entry into the United States. USCIS will work with the Centers for Disease Control and Protection (CDC) to provide you with a waiver. In this case, they may create conditions on which they will approve your waiver, for example, you are allowed to enter the U.S. provided that you see a doctor immediately and receive treatment if you have a communicable disease. Your waiver can be denied if you refuse to receive treatment. To increase your chances of entry, consider filing a waiver of inadmissibility with the help of an immigration attorney.
What is Form I-693 (“Report of Medical Examination and Vaccination Record”)?
Form I-693 is applicable for multiple processes, such as adjustment of status and consular processing. When completed, the form allows USCIS to determine that you are not inadmissible to the United States. This form is required to confirm that you meet government standards for public health. A civil surgeon must approve and sign your physical form in order for your Form I-693 to be legitimate.
Make sure you have the latest version of the form by downloading the form directly from the USCIS website. If you file an old version, USCIS may reject it and ask you to resubmit the correct version. Your application will consequently be delayed.
What to Bring to a Medical Exam
Generally, you will need to bring the following items to your immigration medical exam:
- Form I-693 (“Report of Medical Examination and Vaccination Record”)
- Examination fee — Check with the doctor’s office for payment options prior to the appointment
- Medical insurance card (if applicable) — Check with the doctor’s office to see if they accept your insurance prior to the appointment
- A copy of your medical history
- Your vaccination records
- Government-issued photo ID
- Copies of previous chest X-rays (if applicable)
How to Apply for a Medical Exam
Below is a quick outline of the process. Each step will be explained in detail for both U.S. applicants and foreign applicants.
Step 1. Fill Out Form I-693
Step 2. Find a Doctor For Your Immigration Medical Exam
Step 3. Schedule Your Immigration Medical Exam
Step 4. Review the Medical Exam Checklist
Step 5. Attend Your Immigration Medical Exam
Step 6. After the Immigration Medical Exam
Step 1. Fill Out Form I-693
Everyone who is filing for an Adjustment of Status must complete the immigration medical exam on Form I-693. To avoid confusion, each part is clearly marked as to whom should fill it out. After you fill out your personal information, bring the form to your exam. The approved doctor will complete the rest of the paperwork. Only sign the form if and when the civil surgeon instructs you to do so.
Like with every form, making a mistake on I-693 can cost you days, weeks, or even months. Write legibly and use black ink. Fill out only your specifically assigned sections. We suggest reaching out to an immigration lawyer to ensure that your paperwork is accurate and timely.
Step 2. Find a Doctor For Your Immigration Medical Exam
The medical exam must be conducted by a government-assigned doctor. There are two types of doctors who are eligible to do so: civil surgeons and panel physicians. The right type of doctor for your situation will depend on where you are applying from. Please note that you cannot just go to any regular doctor: there are specific doctors authorized to do this.
If Applying From Within the U.S.
You will need to consult a civil surgeon designated by USCIS. USCIS provides a list of designated civil surgeons that you may use. You may also search for authorized USCIS doctors near you. Fees for the medical exam vary ($100-$500) by the civil surgeon, so make sure to ask about fees and the doctor’s availability. You will be charged extra for required vaccinations, so plan accordingly.
If Applying From Outside of the U.S.
The U.S. embassy or consulate will provide you with a list of authorized panel physicians to perform your examination. In most cases, you will have a choice. Review the specific procedure at your local consulate.
Step 3. Schedule Your Immigration Medical Exam
If Scheduling From Within the U.S.
According to the USCIS, a Form I-693 is only valid when a civil surgeon signs it no more than 60 days before the date an applicant files an I-485, and USCIS makes a decision upon the application within four years from the signature date. In other words, you will only have two months to file your application for permanent residence after you get your medical exam. You should schedule your medical exam in conjunction with your permanent residence application. You can also apply for permanent residency without the medical exam, provided that you intend to get the medical exam to complete the application.
Previously, an approved Form I-693 was only valid for two years, but this has since changed due to the global pandemic. However, the approval can still take up to four years if the civil surgeon signed your I-693 less than or equal to 60 days before submitting your adjustment of status application. This is an area of law that is rapidly evolving. Contact a licensed immigration attorney to discuss your matter.
If Scheduling From Outside of the U.S.
You can schedule the medical exam only after you have your green card interview appointment. These results vary and could be as low as 2 months.
Step 4. Review the Immigration Medical Exam Checklist
Before attending your medical exam, make sure you have these items prepared:
- If you are outside of the U.S., you will need to bring your green card interview appointment letter from the National Visa Center (NVC) to the doctor’s office. This letter will be used to confirm your active application, and you need it to receive an immigration medical exam.
- Form I-693 with your sections filled out (the doctor will fill out their section after your exam)
- An official vaccination record, which must be translated if it is not written in English
- A list of any chronic medical conditions you have, and/or any medication you are taking
- Written certification from your regular doctor detailing any treatment or hospitalization for psychiatric or mental illness, as well as substance or drug abuse (if applicable)
- Information about any history of violent behavior that allows the doctor to potentially attribute the behavior to a psychiatric or medical problem, or to drug or substance use. Such behavior includes attempted suicide or any extent of self-harm.
- Last X-ray films taken (if applicable)
- A report on any disabilities in you or your immigrating family, as well as any requirements they have for special education or supervision
- If you have had syphilis, you need a signed written certificate by a doctor or a public health official that proves you were properly treated. If you were not treated, you need to bring a written explanation signed by your regular doctor.
- If you ever had tuberculosis, you need a written certificate from your regular doctor detailing the circumstances including proof of proper treatment, types of medication prescribed, and how long it lasted.
Step 5. Attend Your Immigration Medical Exam
What to Expect
No matter what you are applying for, the general category of screenings will remain the same. Screenings will include a medical history review, tuberculosis test, vaccination screening, physical exam, mental exam, drug and alcohol, and blood and urine. If you are pregnant, you may ask the U.S. embassy or consular office for the X-ray to be delayed. Usually, children under the age of 15 will not need to have an X-ray or a blood test done.
Like a regular doctor's visit, the immigration medical exam takes just about the same amount of time and might last anywhere between 15 minutes to an hour. It takes approximately one week following the exam to receive your lab results. If any results come back positive for infectious disease, you may need to return for a second visit for further testing.
Vaccination Screening
The exam is straightforward. Your doctor will first review your vaccination and medical history. You must have all of the required vaccines. If you are missing any, the doctor can administer them during the exam.
Vaccination Requirements
Some vaccines are required by the Immigration and Nationality Act, and others are required by the CDC in the interest of public health. Before you can be admitted as a permanent resident, the doctor will ensure that you have had all the necessary vaccinations:
- COVID-19 (currently required - read more below)
- Tetanus and diphtheria toxoids
- Pertussis
- Polio
- Measles, mumps, rubella
- Rotavirus
- Haemophilus influenzae type b (Hib)
- Hepatitis A
- Hepatitis B
- Meningococcal disease
- Varicella
- Pneumococcal disease
- Influenza (if exam is done during the Oct-March flu season)
As more vaccines are developed, this list may be updated with other diseases in the future. Note that not everyone will receive all vaccines, for example, babies are only administered certain vaccines. The USCIS maintains a chart of medically appropriate vaccinations by age, which can be accessed on their website. If you have any medical or age concerns about getting vaccinated, consider contacting an immigration lawyer and applying for a blanket waiver.
Proving COVID-19 Vaccination Status
At the exam, you are required to show evidence that you are fully vaccinated against COVID-19. Acceptable forms of vaccination status proof include:
- Official vaccination record
- Copy of your medical chart
The record must include the dates on which you received the vaccine, and if applicable, the manufacturer and lot number.
Medical History Review
When the doctor checks your medical history, they will specifically note:
- Any hospitalizations or any significant events in your health history
- If you were ever in an institution for chronic mental or physical conditions
- If you were ever unable to function as an average member of society due to an intense sickness or disability
Tuberculosis Exam
Depending on whether you are inside or outside of the U.S., the CDC has different guidelines in testing for tuberculosis.
If Testing Within the U.S.
The doctor is required to conduct a “interferon gamma release assay” (IGRA) test on green card applicants ages two and older. It is likely you will not have to return to the doctor’s office to get your results. If the IGRA test results suggest that you may have tuberculosis, you will have to undergo further testing as well as a chest X-ray.
Note that the USCIS no longer accepts tuberculin skin tests (TST) for green card applicants. Make sure you receive the correct test.
If Testing Outside of the U.S.
Green card applicants that are 15 years old and older and located in a country considered “heavily tuberculosis-burdened” are required to undergo a chest X-ray. If the X-ray or other exam results suggest that you may have tuberculosis, you will have to undergo further testing. Review further tuberculosis exam instructions from your U.S. embassy or consulate.
Physical Exam
During the physical exam, the doctor will most likely examine the following areas:
- Eyes
- Ears
- Nose
- Throat
- Heart
- Lungs
- Abdomen
- Lymph nodes
- External genitalia
- Extremities
- Skin
Blood and Urine Screening
You will also undergo a chest X-ray and a blood and urine test to screen for syphilis, gonorrhea, and other infectious diseases. Children green card applicants under the age of 15 are excused from the X-ray and blood test. Again, if you are pregnant, you may ask the U.S. embassy or consular office for the X-ray to be delayed until after giving birth as the x-ray could harm your pregnancy. However, the X-ray must be completed prior to entering the U.S. (if applying from outside of the U.S.) or prior to the green card interview (if applying from within the U.S.).
Note that all female applicants are required to complete the medical exam even if they are having a menstrual period during the time of the exam.
Drug and Alcohol Screening
You will be asked about any prescription drugs you take, your history and current usage of alcohol and drugs, and whether or not you have a history of substance abuse. If you are still abusing substances, you may become ineligible for a green card. If you can prove you have recovered from substance abuse, you remain eligible.
Mental Exam
The last portion of the exam is a mental status examination. Your cognitive skills, thought, intelligence, comprehension, judgment, mood, and behavior will all be assessed. The doctor will be looking for any signs of a current or past mental or physical disorder that is associated with violent or harmful behavior.
Step 6. After the Immigration Medical Exam
What happens after your examination is dependent on your location.
If You Had Your Medical Exam in the U.S.
The civil surgeon will document the results of the exam on your I-693 and give them to you in a sealed envelope. Do not open this envelope. Submit this envelope with your Form I-485 (“Application to Register Permanent Residence or Adjust Status”) or at the interview. Note that an I-693 is valid only when a civil surgeon signs it no more than 60 days before the date an applicant files an I-485, and USCIS makes a decision upon the application within four years from the date of the civil surgeon’s signature. If you have already filed your I-485, bring the envelope to your USCIS interview.
If You Had Your Medical Exam Outside of the U.S.
The panel physician may directly send the exam results to the U.S. embassy. If not, the panel physician will give you the results of your exam in a sealed envelope and x-ray for you to take to your interview. Do not open the envelope.
Frequently Asked Questions
Q. Can I request a personal-belief waiver from the vaccine requirements?
A. Yes, you are able to request a personal-belief waiver. Check with USCIS to obtain a separate application for a waiver based on religious or moral grounds.
Q. Do all vaccine series have to be completed for the vaccination requirement to be fulfilled?
A. For vaccine series, only a single dose is required for immigration purposes. If the vaccine is not completed, it should be documented to indicate that additional doses will be needed to complete the vaccine, and you should plan on completing that vaccine in the future. The exception to this is the COVID-19 vaccine series.
Q. Can I complete my medical exam in the U.S. if I am a visa applicant that is physically present in the U.S.?
A. No, you are not permitted to have your medical exam in the United States if you will receive a visa at a consular post aborad.
Q. What is the legal basis for requesting a visa applicant's medical information?
A. Medical eligibility is a requirement indicated in Sections 212(a) and 221(d) of the Immigration and Nationality Act (INA). If you are unable to provide the required medical information, your visa may be delayed or even denied. If your visa ends up not being issued, all medical eligibility forms will remain confidential under INA Section 222(f).
Q. Am I allowed to eat before the Immigration Medical Exam?
A. Yes, you are allowed to eat before the exam. You are not required to fast for any of the tests that will be performed.
