How Do You Complete the Immigration Medical Exam With Form I-693?

The examination in one table

Who files the full form, and who files a partial form

Most adjustment applicants file the complete Form I-693. Four groups file a partial form instead: Parts 1 through 5, Part 7, and Part 10, the Vaccination Record. Those groups are refugees on Forms I-590 or I-730 who already completed an immigration medical examination with a panel physician outside the United States; derivative asylees on Form I-730 who were already examined abroad by a panel physician and applied for adjustment within one year of becoming eligible; K-1, K-2, K-3, and K-4 nonimmigrants who were already examined abroad no more than one year before filing, but only when the vaccination record was not properly completed and included in that examination; and Afghan nationals who arrived under Operation Allies Welcome and were already examined abroad by a panel physician.

One exception cuts across all four groups. If the examination outside the United States revealed a Class A medical condition, or there is reason to believe a Class A condition was acquired after admission or parole into the United States, a new examination may be needed. The Form I-693 Instructions govern what to complete in that case.

The sealed envelope, and the online-filing difference

After the examination, the civil surgeon must give the completed form to the applicant in a sealed envelope. Do not accept it if it is not sealed. USCIS returns the form if it is not in a sealed envelope, or if the envelope has been opened or altered.

The applicant, not the civil surgeon, submits the form to USCIS. How the envelope is handled depends on how Form I-485 is filed:

• By mail. Submit Form I-693 with the Form I-485 package, in the original sealed envelope from the civil surgeon, to the filing location for Form I-485. Nothing about this process changed.
• Online. Open the sealed envelope, upload the completed Form I-693 with the application package, and keep the original form and the envelope until USCIS makes a final decision on the Form I-485. USCIS may review the original and the envelope during an interview, or ask for them as evidence.

One refile rule covers a rejected package. If USCIS rejects the package and returns it with the Form I-693 envelope opened, the applicant may file a new package with the original opened Form I-693, any supporting documentation that was previously inside its envelope, and a copy of the rejection notice.

How long the form stays valid

The validity rule turns on the civil surgeon's signature date, and it changed twice in recent years. A form signed on or after November 1, 2023 is valid only for the entire period the immigration benefit application it was submitted with is pending. If that application is withdrawn or denied, a newly completed and signed Form I-693 is required with any future application. Approval is not named as an event that ends validity. A form signed before November 1, 2023 retains evidentiary value for two years from the signature date.

The April 4, 2024 policy that forms signed on or after November 1, 2023 would not expire was reversed on June 11, 2025. Do not rely on articles or checklists that still describe indefinite validity. The signature date also controls which edition and which CDC Technical Instructions apply: requirements that did not apply on the signature date do not draw a request for evidence. There is no 60-day signature rule; USCIS removed it in 2023.

Even a valid form can draw a request for further evidence or a new form if the officer has reason to believe the medical condition changed, or that the form does not accurately reflect the applicant's condition.

The process, step by step

1. Find a designated civil surgeon on the USCIS Find a Civil Surgeon page, and confirm the designation before the appointment. Only a designated surgeon can complete the form.
2. Bring the form, a government-issued photo ID, the vaccination and immunization record, a health-insurance card, and payment. The examination fee varies, so ask about the cost when booking.
3. Complete the examination. It covers a medical-history review, a physical examination, and testing for communicable diseases under the CDC Technical Instructions. Sign the certification only when the civil surgeon instructs.
4. Get a copy of the completed form for personal records before the civil surgeon seals the envelope. Once sealed, the envelope stays sealed unless the filing route requires opening it.
5. Check the edition. The current edition is 01/20/25. If the civil surgeon signs on or before July 2, 2025, either the 03/09/23 or the 01/20/25 edition is accepted; if the surgeon signs July 3, 2025 or later, only the 01/20/25 edition is accepted. All pages must be from the same edition, with the edition date and page numbers visible, and the form must be signed. Unsigned forms are rejected.
6. File with Form I-485. By mail, include the sealed envelope in the package. Online, open the envelope, upload the form, and keep the original and the envelope until a final decision.
7. If the package is rejected and returned with the envelope opened, refile with the original opened form, the supporting documentation from the envelope, and a copy of the rejection notice.

What this guide does not state

The required vaccination list is not stated; the CDC Technical Instructions govern it. Examination components by age band are not stated. No examination price is stated, because the fee varies by civil surgeon. Class A and Class B condition definitions and waiver mechanics are not stated; the Form I-693 Instructions govern them. Processing times are not stated. Form edition and alert currency follows the USCIS pages cited below; check the live Form I-693 page before the appointment, since the edition chain moved during 2025.

Sources

• USCIS, Report of Immigration Medical Examination and Vaccination Record, Form I-693
• USCIS, Application to Register Permanent Residence or Adjust Status, Form I-485
• USCIS, Policy Manual, Volume 8, Part B, Chapter 4, Review of Medical Examination Documentation
• USCIS, Find a Civil Surgeon

Facts verified 2026-10-31.

This page explains how the process works and what the official rules say. It is general information, not legal or medical advice. For advice about a specific situation, talk to a qualified professional or the agency.