Introduction

The USCIS medical exam is a required health screening for most immigration applicants applying for adjustment of status or certain visas. Its main purpose is to ensure applicants do not have communicable diseases or health conditions that would make them inadmissible under U.S. immigration law. Timely completion of this exam is crucial because delays can hold up the entire immigration process, impacting applicants’ plans and lives. In fact, medical exam-related issues account for about 15-20% of Requests for Evidence (RFEs) issued by USCIS each year (USCIS, 2023).

Medical Exam Requirements and Standards

The medical exam is mandated by the Immigration and Nationality Act (INA), specifically Sections 212(a) and 221(d), which set health-related grounds for inadmissibility. The exam includes several key components:

• Physical Examination: 

This is a general health check where the civil surgeon examines areas such as the ears, eyes, nose, throat, heart, lungs, abdomen, skin, and lymph nodes to identify any visible or reported health issues.

• Mental Health Evaluation: 

The doctor screens for mental disorders that might pose a threat to the applicant or others, or indicate an inability to care for oneself.

• Immunizations: 

Applicants must provide proof of vaccination against diseases like measles, mumps, rubella, polio, tetanus, and, until recently, COVID-19 (the COVID-19 vaccine requirement was removed as of January 20, 2025). If vaccines are missing, they must be administered during the exam or before the green card interview.

• Diagnostic Tests: 

These include blood tests for syphilis, urine tests for gonorrhea (for applicants aged 15 and older), and chest X-rays to screen for tuberculosis (TB), a contagious lung disease.

Note: “Communicable diseases” are illnesses that can spread from person to person, such as tuberculosis or measles.

Common Medical Reasons Causing Delays

• Communicable Diseases (e.g., Tuberculosis): 

TB screening is a major cause of delays. If the initial TB test or chest X-ray is positive, applicants may require additional tests or treatment before clearance. According to CDC guidelines updated in 2022, treatment for latent TB infection can last from 3 to 9 months, significantly extending processing times.

• Immunization Gaps: 

Missing required vaccines often cause delays because applicants must receive the vaccines and wait for the immune response, usually about two weeks. The COVID-19 vaccine requirement, introduced in December 2021, affected many applicants but was recently lifted in 2025.

• Additional Testing or Follow-Up: 

If initial exam results reveal abnormalities, such as abnormal blood tests or mental health concerns, civil surgeons may refer applicants for further evaluation by specialists, adding weeks or months to the process.

• Medical Inadmissibility and Waivers: 

Some health conditions, like drug addiction or untreated syphilis, can render applicants inadmissible unless they obtain a waiver. The waiver process can take several months, further delaying the case.

Administrative and Procedural Causes of Delays

• Incomplete or Missing Form I-693: 

This form, officially called the Report of Medical Examination and Vaccination Record, must be completed by an authorized civil surgeon. Missing signatures, incomplete vaccination records, or using expired versions of the form often trigger Requests for Evidence (RFEs), causing delays.

• Policy Changes Affecting Validity: 

Prior to 2018, USCIS accepted medical exams valid for up to two years. However, since February 2018, the validity has been limited to one year from the date signed by the civil surgeon. If adjudication takes longer, applicants must redo the medical exam, adding time and cost.

• COVID-19 Impact: 

The pandemic caused office closures and policy waivers, such as temporary extensions of medical exam validity during 2020-2021, which led to confusion and delays. Although USCIS resumed normal processing by 2023, backlogs remain, continuing to affect processing times.

Systemic and Operational Factors

• High Application Volume: 

In 2023, USCIS received over 1.5 million adjustment of status applications, a huge volume that strains the agency’s resources and contributes to longer processing times. This surge in applications means more cases waiting in line, which naturally slows down each step, including medical exam processing. 

• Staffing Shortages: 

Both USCIS and the network of authorized civil surgeons face personnel shortages. For USCIS, this is due to retirements, hiring freezes in past years, and challenges in recruiting qualified staff to handle the growing caseload. Civil surgeons also struggle with limited availability, as fewer doctors are authorized or willing to perform immigration medical exams, especially in busy metropolitan areas. This shortage reduces the number of available appointments and slows down exam completion.

• Pandemic-Related Disruptions: 

While most COVID-19 related closures and restrictions ended by mid-2022, some residual effects lingered into early 2023, including backlogs and reduced office hours in certain locations. However, as of 2025, USCIS and civil surgeons have largely returned to normal operations, though the backlog created during the pandemic still impacts processing speed.

• Coordination Challenges: 

Delays often occur when communication between USCIS, civil surgeons, and applicants is inefficient. For example, slow transfer of medical records or incomplete documentation can hold up case adjudication. USCIS has been working on improving coordination by digitizing records and providing clearer guidance to civil surgeons, but gaps remain. Effective communication is essential to ensure medical exam results are properly submitted and reviewed in a timely manner.

Applicant-Related Factors Contributing to Delays

• Scheduling Delays: 

Applicants frequently face long waits to book appointments with USCIS-authorized civil surgeons, especially in high-demand areas like New York City, Los Angeles, and Houston. In some cases, applicants report waiting several weeks or even months for an available slot, which can push back their entire immigration timeline.

• Incomplete Medical History: 

Failing to disclose prior illnesses, treatments, or vaccination records can lead to additional testing or follow-up exams, causing delays. Full transparency during the exam helps civil surgeons complete the medical evaluation accurately and quickly.

• Delayed Response to RFEs: 

A Request for Evidence (RFE) is a formal USCIS notice asking applicants to provide missing or additional information. For medical exams, RFEs commonly request updated Form I-693 or missing vaccination records. USCIS typically allows 87 days to respond. Missing this deadline can result in case denial or further delays, as the application may be put on hold until the required documents are submitted. 

• Vaccination Compliance: 

Applicants must complete all required vaccinations, which may require multiple visits and waiting periods for immune response (usually about two weeks). Delays occur if applicants need to schedule additional appointments or if vaccines are not administered timely.

Pain Points Experienced by Applicants

• Impact on Immigration Status: 

Delays in medical exam processing can affect critical aspects like work permit issuance, travel authorization, and family reunification. For example, a delayed medical exam can postpone a green card approval, which in turn delays eligibility for employment authorization or travel documents.

• Complexity of Medical Requirements: 

Many applicants struggle to understand evolving vaccination requirements and health standards, especially with recent changes such as the addition and then removal of the COVID-19 vaccine mandate. The medical exam involves unfamiliar medical terms and procedures, which can be confusing and intimidating, adding to applicants’ stress.

Tips to Mitigate Delays

• Prepare in Advance: 

Review your vaccination records early and get any missing vaccines before scheduling your medical exam to avoid last-minute delays.

• Choose Experienced Civil Surgeons: 

Use the USCIS online locator tool to find authorized doctors who are familiar with current USCIS medical exam requirements and have a reputation for timely service.

• Submit a Complete Form I-693: 

Ensure every section of the form is fully completed, signed by the civil surgeon, and submitted within the validity period to avoid RFEs.

• Stay Informed: 

Regularly check USCIS announcements, policy updates, and processing times to anticipate any changes that might affect your case.

• Respond Promptly to USCIS: 

If you receive an RFE, act quickly to gather and submit the requested documents. Keep copies of all submissions for your records.

Conclusion

Delays in USCIS medical exam processing arise from a mix of medical, administrative, systemic, and applicant-related factors. Understanding these causes, especially the medical requirements and procedural policies, helps applicants navigate the process more confidently. Staying proactive, well-prepared, and informed is essential to minimizing delays and achieving a smooth immigration journey.