Form I-693, officially known as the Report of Immigration Medical Examination and Vaccination Record, is a critical document for anyone seeking to adjust their status to a lawful permanent resident in the United States. While it might appear to be just another PDF to download and print, it represents a mandatory health screening process designed to ensure that applicants are not inadmissible to the U.S. on health-related grounds. Failing to handle this form correctly—using an outdated version, opening the sealed envelope, or seeing the wrong type of doctor—can result in a Request for Evidence (RFE) or an outright rejection of your Green Card application.

To obtain the official Form I-693 PDF, applicants must always visit the official U.S. Citizenship and Immigration Services (USCIS) website. Downloading the form from third-party websites is strongly discouraged, as immigration forms are updated frequently. Using a version that is no longer accepted is one of the most common reasons for filing delays.

Understanding the Purpose of Form I-693

The primary objective of Form I-693 is to provide USCIS with the results of a comprehensive medical examination. This exam proves that an applicant is not a threat to public health. The examination is conducted by a USCIS-designated civil surgeon who evaluates the applicant for communicable diseases of public health significance, physical or mental disorders associated with harmful behavior, and drug abuse or addiction.

Additionally, the form serves as a certified record of the applicant’s vaccinations. Under U.S. immigration law, applicants must be vaccinated against several diseases, including mumps, measles, rubella, polio, tetanus, and diphtheria toxoids, among others. The civil surgeon’s role is to verify that you have received these vaccines or to administer them if they are missing from your records.

The 2025 Version and Edition Date Requirements

One of the most technical aspects of handling the I-693 PDF is ensuring the edition date is correct. USCIS periodically updates the form to reflect new health guidelines from the Centers for Disease Control and Prevention (CDC).

As of early 2025, the current edition of Form I-693 is dated 01/20/25. It is crucial to check the bottom of the pages on the PDF to verify this date. USCIS has established specific grace periods for older versions:

  • If the civil surgeon signs the form on or before July 2, 2025, USCIS will accept either the 03/09/23 edition or the new 01/20/25 edition.
  • If the civil surgeon signs the form on or after July 3, 2025, only the 01/20/25 edition will be accepted.

Submitting a form with the wrong edition date is a common administrative error. When you print the 14-page PDF, ensure that the edition date and page numbers are clearly visible at the bottom of every single page. If the printer cuts off these margins, USCIS may reject the form as incomplete.

Finding a USCIS-Designated Civil Surgeon

You cannot go to your regular primary care physician for this examination unless they are specifically designated as a civil surgeon by USCIS. A civil surgeon is a doctor who has been authorized by the government to perform immigration medical exams and has the authority to sign Form I-693.

To find an authorized doctor, you should use the "Find a Doctor" tool on the USCIS website. You will enter your zip code, and the system will provide a list of local practitioners. It is highly recommended to call multiple offices, as prices for the I-693 exam are not regulated by the government and can vary significantly—ranging from $200 to over $600, excluding the cost of required labs and vaccinations.

The Medical Examination Process Step-by-Step

Navigating the medical exam requires preparation and typically involves two or more visits to the clinic. Based on standard clinical practices for immigration exams, here is what you can expect during the process.

The Initial Consultation

During the first visit, the clinic staff will review your demographic information. You should have your I-693 PDF already printed, with Part 1 filled out. However, do not sign the form yet. The signature must be performed in the presence of the civil surgeon at the final appointment.

The staff will review your vaccination records. If you have records from your home country, they must be translated into English. If you lack records, the doctor will order "titers"—blood tests that check for immunity to specific diseases like Measles, Mumps, Rubella, and Varicella (Chickenpox). If the titers show you are not immune, you will need to receive the vaccines.

Laboratory Testing

The civil surgeon will order specific blood and urine tests required by the CDC. These tests typically target:

  • Tuberculosis (TB): The most common test is the IGRA (Interferon-Gamma Release Assay), such as the QuantiFERON-TB Gold or T-SPOT test. If this test comes back positive, a chest X-ray is mandatory to rule out active tuberculosis.
  • Syphilis (RPR): Required for applicants of a certain age range (typically 18 to 44).
  • Gonorrhea: A urine test required for applicants aged 18 to 24.

In our practical experience with these clinics, the lab results usually take 3 to 5 business days to return to the surgeon's office. It is important to note that you do not need to fast for these specific tests.

The Physical Examination

Once the lab results are in, you will return for a physical exam. The civil surgeon will check your height, weight, blood pressure, and vision. They will perform a basic physical check, including listening to your heart and lungs and examining your skin for signs of infectious diseases. They will also conduct a brief mental health screening, asking questions about history of substance use or psychiatric hospitalizations.

The COVID-19 Vaccine Requirement Status

As of January 2025, there have been updates regarding the COVID-19 vaccine requirement for adjustment of status applicants. While the requirement was strictly enforced in previous years, USCIS and CDC guidelines are subject to change based on public health conditions. Currently, many applicants have noted a shift toward waivers or reduced requirements depending on the specific edition date of the form being used. It is vital to confirm with your civil surgeon whether the COVID-19 series is mandatory for your specific filing window.

The Critical "Sealed Envelope" Protocol

The most important rule regarding Form I-693 is the Sealed Envelope Rule. After the exam is completed and the form is signed by both you and the doctor, the civil surgeon will place the original Form I-693 and all supporting lab results into an envelope and seal it.

Do not open this envelope under any circumstances.

If the seal is broken or the envelope shows signs of tampering, USCIS will reject the form. You must submit the envelope in its original, sealed state along with your I-485 application package. Most civil surgeons will provide you with an unsealed photocopy of the completed form for your personal records. Always ensure you receive this copy so you know exactly what was reported to the government.

Exceptions for Online Filing

If you are filing Form I-485 online (a service currently available for certain employment-based applicants), the protocol changes. In this specific case, you are instructed to open the sealed envelope from the civil surgeon, scan the document, and upload the PDF to the USCIS portal. However, you must keep the original physical form and the opened envelope in a safe place. USCIS may request the original at a later date or during your interview.

Filing Timeline: When to Submit Form I-693

A major policy shift occurred in late 2024. Effective December 2, 2024, USCIS requires that Form I-693 be submitted concurrently with the Form I-485 application for adjustment of status.

In the past, many attorneys suggested waiting for a Request for Evidence (RFE) or bringing the medical exam to the interview to ensure the form didn't expire. However, current policy states that if the medical exam is missing from the initial filing, USCIS may reject the entire I-485 package. This change is part of an effort to streamline processing and reduce the backlog of applications.

Validity and Expiration Rules

For a long time, the "two-year rule" governed I-693 validity. However, current USCIS guidance has simplified this. Form I-693 is now considered valid indefinitely if it was signed by a civil surgeon on or after November 1, 2023, and it is submitted while the underlying application is still pending.

This is excellent news for applicants stuck in long visa backlogs, as it eliminates the need to pay for a second medical exam if the Green Card process takes longer than two years. However, if the medical exam was signed before November 1, 2023, the old expiration rules likely apply, and a new exam might be necessary.

Common Mistakes to Avoid

  1. Signing Too Early: Do not sign Part 1 of the PDF until you are physically in the clinic and the doctor or their staff instructs you to do so.
  2. Incomplete Vaccination Records: If you have had vaccines but cannot prove them with a signed medical record, the doctor must treat you as if you haven't had them. This might mean getting duplicate shots, which is safe but adds to your cost.
  3. Missing Pages: The PDF is long. Ensure you print and include all 14 pages, even if some sections are blank because they don't apply to you.
  4. Incorrect Ink: USCIS prefers black ink for any handwritten portions. Using blue or red ink can occasionally cause scanning issues in their automated systems.
  5. Using a Panel Physician: Panel physicians are for people applying for visas outside the U.S. If you are inside the U.S. adjusting status, you must see a Civil Surgeon.

Estimated Costs for the I-693 Process

While the form itself has no filing fee to USCIS, the medical process is a private transaction. In our analysis of current market rates in major metropolitan areas:

  • Basic Exam Fee: $250 - $450
  • Required Labs (TB, Syphilis, Gonorrhea): $150 - $300
  • Vaccinations: Variable. If you have health insurance, most pharmacies (CVS, Walgreens, etc.) will cover these vaccines at zero cost to you under "preventative care." It is almost always cheaper to get your shots at a pharmacy using insurance before your final doctor's visit than to pay the civil surgeon's out-of-pocket rates.

What is a Class A Medical Condition?

During the review of your I-693 PDF, you might see references to "Class A" or "Class B" conditions.

  • Class A conditions make an applicant inadmissible. These include active infectious tuberculosis, certain venereal diseases, and mental disorders with harmful behavior. If a Class A condition is found, the applicant must undergo treatment and be cleared before the I-693 can be completed, or apply for a specific waiver (Form I-601).
  • Class B conditions are physical or mental abnormalities that are notable but do not make you inadmissible. Examples include successfully treated tuberculosis or well-managed chronic illnesses. These do not stop your Green Card process but are recorded for public health tracking.

Summary of the I-693 Workflow

To ensure a smooth application, follow this streamlined workflow:

  1. Download the latest 01/20/25 edition of the I-693 PDF from the official USCIS site.
  2. Locate a designated Civil Surgeon via the "Find a Doctor" tool.
  3. Gather all foreign vaccination records and have them translated.
  4. Fill out Part 1 of the form but do not sign it.
  5. Attend the first clinic visit for blood draws and record review.
  6. Complete any missing vaccinations at a local pharmacy to save costs.
  7. Return for the physical exam, sign the form in front of the doctor, and receive your sealed envelope.
  8. Submit the sealed envelope with your I-485 package.

Conclusion

The I-693 form is more than just a medical checkup; it is a legal requirement that demands strict adherence to procedural rules. By ensuring you have the most recent PDF version, verifying the credentials of your civil surgeon, and respecting the integrity of the sealed envelope, you can avoid the most common pitfalls that delay the path to a Green Card. The recent 2025 updates emphasize the need for concurrent filing and the use of updated form editions, making it more important than ever to stay informed on the latest USCIS and CDC guidelines.

FAQ

What happens if I accidentally open the I-693 sealed envelope?

If you open the envelope, the medical exam is considered invalid for USCIS purposes. You must return to the civil surgeon. Depending on the clinic's policy, they may be able to re-seal it for a small administrative fee, or they may require a new physical exam if a significant amount of time has passed.

Do children need to complete Form I-693?

Yes, all applicants for adjustment of status, regardless of age, must submit Form I-693. However, the specific tests and vaccinations required are age-dependent. For example, children under a certain age are not required to undergo syphilis or gonorrhea testing.

Can I use a medical exam from my home country?

Generally, no. Immigration medical exams conducted by panel physicians outside the U.S. are for consular processing. If you are already in the U.S. and filing for a Green Card via adjustment of status, you must have a new exam performed by a U.S.-based civil surgeon, with very few exceptions for certain refugees and K-visa holders who have recently arrived.

How long does it take to get the completed I-693 back?

Most clinics return the completed, sealed envelope within 7 to 10 business days. This delay is usually due to the time required for the laboratory to process the tuberculosis blood test and the syphilis screen.

Is the COVID-19 vaccine still required in 2025?

As of late 2024 and early 2025, USCIS policy has shown flexibility, including specific waivers or updated guidance for certain applicant groups. You must check the most recent "Technical Instructions for Civil Surgeons" on the CDC website or ask your designated doctor for the current month's requirements.

Where can I find the official I-693 PDF download?

The only safe and official source is the USCIS website under the "Forms" section. Always look for the ".gov" extension in the URL to ensure you are not on a predatory third-party site.

Can I file the I-693 after I have already submitted my I-485?

While this was common in the past, new rules effective December 2024 strongly encourage or require concurrent filing. Filing it later may now lead to a rejection of the initial application package in many cases, rather than just an RFE.