Why the Medical Exam Matters
Everyone applying for a green card must show they are not inadmissible on health-related grounds (INA 212(a)(1)). For people applying inside the United States through adjustment of status, that showing is made on Form I-693, Report of Immigration Medical Examination and Vaccination Record, completed by a USCIS-designated civil surgeon (8 USCIS-PM B.4).
Two changes since late 2024 have made timing and completeness more important.
Change 1: File It With the I-485
Effective December 2, 2024, applicants must submit Form I-693 (or, for certain categories, a partial I-693 such as the vaccination record) with Form I-485. If it is missing, USCIS may reject the I-485. USCIS added this requirement to reduce Requests for Evidence for the medical exam (USCIS Policy Alert PA-2025-08).
- Filing by mail: include the I-693 in the original sealed envelope from the civil surgeon.
- Filing online: open the sealed envelope, upload the completed I-693, and keep the original form and envelope until a final decision, since USCIS may ask to see them.
- If the package is rejected and returned with the envelope opened, USCIS's form page states that you may refile with the original opened I-693 and its supporting documents in the original envelope, along with a copy of the rejection notice.
Change 2: Valid Only for That Application
For an I-693 signed by a civil surgeon on or after November 1, 2023, USCIS's current policy is that it can be used only for the application it was submitted with, for as long as that application is pending (8 USCIS-PM B.4(C)(4); PA-2025-08, effective June 11, 2025).
- If that I-485 is denied or withdrawn, you need a new I-693 for any later application.
- A medical exam from an earlier filing can no longer be reused for a new one.
- Even a valid I-693 can be questioned: officers may request further evidence or a new form if they have reason to believe it no longer reflects the applicant's condition.
This reversed a 2024 policy that had treated these forms as having no expiration date.
What Makes an I-693 Acceptable
The Policy Manual lists requirements that must always be met (8 USCIS-PM B.4(C)(2)):
- Completed legibly, with all required parts filled in
- Signed and dated by the civil surgeon who did the exam, and by the applicant
- Signed by any physician who completed a referral evaluation, if applicable
- Still valid
- In a sealed envelope, as the form instructions describe
Only physicians designated by USCIS as civil surgeons may perform the exam, and they must be designated when they complete it. The civil surgeon must use the edition of Form I-693 in use when they sign it, and the exam is reviewed under the CDC Technical Instructions in effect on that date. Requirements added later generally do not apply retroactively, so an officer should not require new tests that did not apply on the signature date (8 USCIS-PM B.4(C)).
Use USCIS's "Find a Civil Surgeon" tool to locate a designated physician.
Timing the Exam
Because the I-693 now has to be ready before the I-485 is filed, the exam becomes part of filing preparation:
- Watch the Visa Bulletin. Adjustment can be filed only when a visa is available for your category and priority date. Scheduling the exam ahead of an expected filing month helps avoid delay. See our guide to the Visa Bulletin and priority dates.
- Concurrent filing. EB-1A, EB-1B, EB-1C, and NIW applicants whose priority date is current can file the I-485 together with the I-140; the I-693 needs to be ready for that package. See our guide to adjustment of status vs. consular processing.
- Family members. Each derivative spouse and child filing an I-485 needs their own I-693. For children close to 21, see our guide to the CSPA and aging out.
- Allow time for follow-up. If the civil surgeon refers you for further evaluation or treatment, they cannot sign until it is complete.
- File complete. Under USCIS's August 2026 evidence policy, missing required initial evidence can lead to denial without a request for evidence. See our guide to USCIS's 2026 evidence policy.
Consular Processing Is Different
Applicants who get their green card through an immigrant visa abroad do not use Form I-693. Their medical exam is done by a panel physician designated by the Department of State, following the consulate's instructions.
Key Takeaways
- Since December 2, 2024, Form I-693 must be filed with Form I-485, or USCIS may reject the I-485.
- An I-693 signed on or after November 1, 2023 is valid only for the application it was filed with; a denied or withdrawn application means a new exam.
- Only USCIS-designated civil surgeons can complete the exam, using the form edition current when they sign.
- Mail filers include the sealed envelope; online filers upload the form and keep the original.
- Schedule the exam as part of filing preparation, especially when a priority date is about to become current.
Preparing to file for adjustment of status? Schedule a consultation to plan the filing package and timeline.
Sources and References
- USCIS Policy Manual, Volume 8, Part B, Chapter 4: Review of Medical Examination Documentation
- USCIS Policy Alert PA-2025-08, Validity of Form I-693 (June 11, 2025)
- USCIS, Form I-693, Report of Immigration Medical Examination and Vaccination Record
- INA § 212(a)(1) (8 U.S.C. § 1182): Health-related grounds of inadmissibility
This document provides general information only and does not constitute legal advice. Immigration law is complex and individualized. Outcomes depend on specific facts and circumstances. No results are guaranteed. Always consult with a qualified immigration attorney before making decisions about your immigration case.
About Kevin J Andrews
Kevin J Andrews is a business immigration attorney with 15+ years of experience specializing in EB-1A, O-1A, NIW, and L-1 petitions. He is the founder of Kevin J Andrews Law.