When applying for a green card from inside the United States, there is one step that every applicant must complete correctly to avoid delays. This is a Request for Evidence (RFE) for an immigration medical exam, officially documented on Form I-693. 

Many applicants don’t realize that this form is far more than routine paperwork. It is a legally required health screening that allows U.S. Citizenship and Immigration Services (USCIS) to confirm that you are medically eligible for permanent residence under the Immigration and Nationality Act.

For many applicants, this part of the process can feel confusing, especially when they are already managing multiple immigration forms and instructions. Understanding the purpose of Form I-693 and exactly what USCIS is looking for can help you prepare properly, avoid repeat exams, and move your application forward without unnecessary delays.

In this guide, we will break down why Form I-693 exists, who needs it, what happens during the exam, how long it remains valid, and how to prepare for your appointment so that you can feel confident and fully informed every step of the way.

What Is Form I-693?

Form I-693 is the official medical report that USCIS uses for your green card case.
It is called “Report of Immigration Medical Examination and Vaccination Record.”
You can think of it like this:

• The exam happens in a clinic.

• The results live on Form I-693.

• USCIS looks only at this form to decide if you meet the health rules.

You cannot take this exam with just any doctor. It must be done by a USCIS-designated civil surgeon (a doctor approved by USCIS for immigration exams).

This is what Form I-693 does in your case:

• It shows if you have any serious infectious disease that U.S. law cares about.

• It shows if you received the required vaccines for your age and category.

• It notes if you have certain mental or physical health issues linked to harmful behavior.

• It notes if you have a drug abuse or addiction problem under U.S. immigration rules.

The form has different parts:

• You fill in your name and basic details.

• The civil surgeon fills in your exam results, test results, and vaccine record.

• At the end, the civil surgeon signs and seals the form in an envelope for USCIS.

USCIS will not accept:

• A copy that you printed and filled out yourself.

• Old clinic notes instead of the official form.

• A form that is not sealed or has a broken seal.

Because of this, Form I-693 is the only medical document USCIS trusts for your immigration medical exam.

Why USCIS Requires the Medical Exam

U.S. immigration law says some people cannot be granted a green card if they have certain health problems. These are called “health-related grounds of inadmissibility” under section 212(a)(1) of the Immigration and Nationality Act.

The exam and Form I-693 help USCIS check four main areas:

1. Communicable Diseases of Public Health Significance

USCIS needs to know if you have certain infectious diseases that can spread in the community.
The civil surgeon must test for:

• Tuberculosis (TB) – usually a TB blood test first, then a chest X-ray if needed

• Syphilis – blood test for people in certain age groups or if there is concern

• Gonorrhea – lab test in required age groups or if there is concern

If a serious disease is found, the doctor follows CDC treatment rules and may refer you to the local health department. USCIS then decides if:

• You are inadmissible, or

• You can qualify for a waiver after proper treatment

2. Required Vaccinations

The U.S. wants new permanent residents to be protected from vaccine-preventable diseases.
So USCIS checks through Form I-693 if you have received vaccines that the CDC requires for immigration, based on your age.

The civil surgeon will:

• Review your vaccine records

• Mark, which vaccines have you already had

• Give you the missing vaccines if they are medically appropriate and available

• Note if a vaccine is not medically appropriate (for example, age, pregnancy, allergy) or if you may qualify for a waiver

3. Physical or Mental Disorders With Harmful Behavior

The law is not saying that having a mental or physical condition alone makes you inadmissible.
What matters is whether that condition is linked to harmful behavior that:

• Hurts you

• Hurts others

• Damages property

During the exam, the civil surgeon may ask about:

• Past hospitalizations

• Self-harm attempts

• Violence or dangerous behavior

• Serious accidents are tied to a mental or substance issue

If there is a current disorder with harmful behavior, or a history of harmful behavior that is likely to come back, the doctor must note this on Form I-693. USCIS uses that note to decide if you fall under a Class A condition (which can make you inadmissible) or if a waiver is needed.

4. Drug Abuse or Drug Addiction

USCIS must also check if you have a current substance use disorder involving drugs listed in the federal controlled substances schedules.

The civil surgeon will ask about:

• Current drug use

• Past drug use

• Treatment or rehab history

Suppose the doctor diagnoses drug abuse or addiction under the legal standards. In that case, you may be found inadmissible on health grounds until the condition is in remission and documented at a later exam.

How All of This Ties Back to Form I-693

Every one of these checks, diseases, vaccines, mental and physical conditions, and drug use is captured in a standard format on Form I-693. That is why USCIS requires:

• A specific doctor (civil surgeon)

• A specific form (I-693)

• A sealed envelope

This process helps USCIS:

• Protect public health

• Apply the law the same way to everyone

• Keep your personal medical details confidential while still making a clear decision on your case

Who Needs Form I-693?

Most people who apply for a green card from inside the United States must submit Form I-693. This form is required for almost all adjustment of status (Form I-485) applicants because USCIS must confirm that you meet the health standards for permanent residence.

But this is the part many applicants misunderstand:
Not everyone needs the full exam. Some need only the vaccination portion, depending on their immigration category and medical history.

Here is a clear breakdown:

1. Most Green Card Applicants (I-485 Applicants)

If you are applying for adjustment of status inside the U.S., you almost always need a complete Form I-693.
This includes applicants filing through:

• Family petitions

• Employment-based petitions

• Diversity lottery

• Marriage-based applications

• Most humanitarian categories

2. Applicants With a Medical Exam Completed Abroad

Some people have already completed a medical exam with a panel physician in their home country before entering the U.S. These groups may only need the vaccination record completed, which includes:

• Refugees adjusting status

• K-1 fiancé(e) visa holders and their children

• K-3 spouses and K-4 children

• Certain asylee derivatives

• Certain Afghan nationals entering under special programs

If the medical exam is done abroad:

• Did not find a Class A condition, and

• Was completed within the allowable timeframe,

Then you usually only need the vaccinations section completed in the U.S., not a full exam.

3. Applicants With No Vaccination Records

If your overseas medical exam didn’t include a vaccination record, or if it was incomplete, USCIS requires a civil surgeon in the U.S. to redo the vaccination section on Form I-693.

4. Applicants Asked to Submit Form I-693 Later

Some people prefer to file Form I-485 without the medical exam and wait for:

• A USCIS Request for Evidence (RFE)

• A green card interview

In these cases, you still need Form I-693; you’re just giving it to USCIS at a later step.

Sealed Form I-693: How It’s Completed and Delivered

After your medical exam is finished and all lab results are back, the civil surgeon completes the required sections of Form I-693 and prepares it for USCIS. This step is extremely important because USCIS will reject any form that is not sealed correctly.

Here’s how the process works at a civil surgeon’s office:

1. The Civil Surgeon Completes All Required Parts

The doctor fills out:

• Your medical exam results

• Lab test results

• Vaccination record

• Any required follow-up or referral notes

• The final medical decision (Class A, Class B, or no condition)

Once everything is complete, the civil surgeon signs the form with an original handwritten signature.

2. The Form Is Placed Into a Special Envelope

USCIS requires that the civil surgeon, not the patient, place Form I-693 inside a secure envelope. The packet includes:

• The completed form

• Any supporting test results

• Any required documentation for referrals or treatments

3. The Envelope Is Officially Sealed

The doctor seals the envelope in a way that clearly shows if it has been opened. Typical civil surgeon steps include:

• Sealing the flap

• Writing initials across the seal

• Placing clear tape over the initials and seal area

• Marking the front with “DO NOT OPEN. FOR USCIS USE ONLY.”

4. You Receive the Sealed Envelope

You must take this envelope and give it to USCIS when:

• Filing your I-485 packet,

• Responding to a USCIS RFE, or

• Bring documents to your green card interview.

5. Do Not Open the Envelope

If you open it, even slightly, USCIS will reject it, and you may be required to retake the entire exam.

6. You Also Receive a Copy for Your Records

The civil surgeon gives you a personal copy of the completed Form I-693.
This copy is for your records and can be helpful:

• If USCIS asks questions,

• If you need vaccine information later,

• Or if you need to show proof of your medical history.

Validity Period of Form I-693

Since late 2023, the rules for how long a completed Form I-693 remains valid have changed. 

• If the civil surgeon signs I-693 on or after November 1, 2023, then the form does not expire for the duration of your immigration benefit application (for example, your application for adjustment of status with Form I-485). 
• However, if your application is withdrawn or denied, the I-693 becomes invalid. If you apply again later, you will need a new medical exam and a new I-693.
• For I-693 forms signed before November 1, 2023, the old rule still applies: they remain valid for 2 years from the date the civil surgeon signed the form.

Because of these rules, it’s important to time your medical exam appropriately, especially if you’re close to filing your I-485. If your exam is too old, or your application fails, you may need to repeat it.

How to Prepare for Your Appointment

To make your I-693 medical exam go smoothly and avoid delays, here’s what you, or anyone visiting a civil surgeon clinic, should bring and prepare in advance:

✔️ What to Bring with You

• A valid government-issued photo ID (passport, driver’s license, etc.). If you’re under 14, bring acceptable ID showing your name, date/place of birth, and parents’ full names (birth certificate + translation or affidavit if needed).
• The latest version of Form I-693 (download it from the USCIS website), with Part 1 completed, but do not sign it until the civil surgeon directs you to.
• Vaccination records from your home country, prior doctors, or any U.S. vaccinations include as much detail as you can (dates, type of vaccine, etc.). 
• Any medical history documents you have — prior diagnoses, treatments, chest X-rays, TB tests, lab reports, or anything related to communicable diseases or chronic conditions.
• A list of any medications you currently take. This can help the civil surgeon see if any follow-up is needed.

✔️ What to Expect / How to Prepare

• Try to arrive early and with all documentation. Missing vaccine records, old lab tests, or incomplete forms often cause delays or even require rescheduling.

• If you lack certain required vaccinations, that’s okay. The civil surgeon can often administer needed vaccines, per the rules of Centers for Disease Control and Prevention (CDC).

• If you have a history of TB, communicable diseases, or have had prior unusual medical conditions, bring all relevant documentation (treatment history, labs, X-rays). This helps the civil surgeon complete the exam properly.

• Do not sign the form before your exam, and bring it with you. The civil surgeon must see you sign Part 1 in person before starting.

• Be ready for tests: physical exam, sometimes blood work, possibly TB screening, vaccination review, depending on your age and health history.

✔️ Tips to Avoid Common Mistakes

✅ What to Do	❌ What to Avoid
Bring all prior medical & vaccination records	Coming empty-handed or with incomplete records
Use the latest I-693 edition from the USCIS website	Using outdated or old versions of the form
Don’t sign Form I-693 until instructed	Signing the form before the exam will result in rejection
Be upfront about past medical history or vaccines	Forgetting or hiding past conditions or treatments
Plan ahead; clinics may be busy, and vaccinations may need scheduling	Waiting until the last minute to book the exam

Conclusion

So Form I-693 is more than a routine step in the green card process. It is the document that proves you meet the health standards required by U.S. immigration law. By confirming your vaccination history, screening for certain medical conditions, and documenting everything in one official report, this form helps USCIS make a clear decision on your application without delays or extra requests for evidence.

When you understand why the exam is required, who needs it, and how the sealed form must be handled, the entire process becomes much easier and far less stressful. Preparing the right documents, bringing accurate vaccination records, and choosing a qualified USCIS-designated civil surgeon can save you time and prevent avoidable setbacks.

If you’re applying for a green card and need a reliable, timely, and USCIS-compliant immigration medical exam in New Jersey, our clinic is here to help. We provide full I-693 exams, required vaccinations, TB testing, and same-day sealed results so you can move forward confidently with your immigration journey.