Latest Guidelines for Downloading and Completing the Form I-693 PDF in 2025

Form I-693, officially titled the Report of Immigration Medical Examination and Vaccination Record, is a mandatory document for most individuals applying for adjustment of status to become a lawful permanent resident of the United States. As of early 2025, several critical updates have been implemented by the U.S. Citizenship and Immigration Services (USCIS), including changes to the form version, vaccination requirements, and submission protocols for online filers.

The primary purpose of the Form I-693 PDF is to demonstrate that an applicant is not inadmissible to the U.S. on public health grounds. This involves a comprehensive medical examination, a review of vaccination records, and testing for specific communicable diseases. Success in this stage of the Green Card process depends on using the correct form edition and following a precise sequence of events involving a USCIS-designated civil surgeon.

Official Source for the Form I-693 PDF

To ensure the validity of an application, the Form I-693 PDF must always be obtained directly from the official U.S. Citizenship and Immigration Services website at uscis.gov/i-693. Downloading the form from third-party websites or utilizing "pre-filled" templates from unofficial sources is high-risk behavior that often leads to the rejection of the entire I-485 application package.

USCIS frequently updates its forms to include new barcodes or data fields. The current official edition of Form I-693 is dated 01/20/25. While the 03/09/23 edition remains acceptable if signed by a civil surgeon on or before July 2, 2025, any medical examination signed on or after July 3, 2025, must exclusively use the 01/20/25 version. Applicants should check the edition date located at the bottom of every page of the PDF to confirm compliance.

Technical Recommendations for the PDF

When accessing the Form I-693 PDF, technical compatibility is essential for data integrity. USCIS utilizes 2D barcode technology at the bottom of the forms to expedite data entry.

Use Adobe Acrobat Reader: It is highly recommended to open and complete the form using the latest version of Adobe Acrobat Reader rather than a web browser’s built-in PDF viewer. Browser viewers often fail to render the barcodes correctly, which can trigger manual processing delays or rejections at the USCIS lockbox.
Black Ink Only: If the form is filled out by hand after printing, USCIS requires the use of black ink. Typing directly into the PDF before printing is preferred for clarity.
Single-Sided Printing: Ensure all 14 pages of the form are printed single-sided. Double-sided printing can interfere with scanning equipment used by immigration officers.

Critical Updates for 2025 Applicants

The beginning of 2025 brought significant changes to the medical examination landscape. Understanding these updates is crucial for avoiding unnecessary costs and delays.

COVID-19 Vaccination Requirement Waived

One of the most notable shifts occurred on January 22, 2025. USCIS officially waived the COVID-19 vaccination requirement for adjustment of status applicants. Previously, applicants were required to show proof of a completed primary series or updated boosters. Under the new guidance, civil surgeons are no longer required to verify COVID-19 vaccination status for Form I-693 completion. This change simplifies the process significantly for many applicants who had difficulty accessing specific vaccine brands or records.

Online Filing and the Sealed Envelope

A common point of confusion involves the handling of the completed medical report. Traditionally, the I-693 was always submitted in a sealed envelope that the applicant was strictly forbidden to open.

For Mail-In Applications: The traditional rule still applies. The civil surgeon provides the completed form in a sealed envelope. If the seal is broken, USCIS will reject the form. The applicant must mail this sealed envelope along with their Form I-485 package.
For Online Filing: If an applicant is filing Form I-485 online (currently available for certain employment-based categories), they must open the sealed envelope provided by the civil surgeon to scan and upload the document. However, the applicant must retain the original physical form and the opened envelope, as USCIS may request to inspect them during a subsequent interview or through a Request for Evidence (RFE).

Step-by-Step Breakdown of Form I-693 Sections

The Form I-693 PDF is 14 pages long, divided into multiple parts that must be completed by specific parties. Errors in these sections are the leading cause of "Requests for Evidence" (RFEs).

Part 1: Information About the Applicant

This section is the responsibility of the applicant. It requires basic biographical data:

Full legal name (avoid nicknames).
Current physical address within the United States.
Date of birth and country of birth.
Alien Registration Number (A-Number), if one has already been assigned.
USCIS Online Account Number, if applicable.

Applicants should complete this section before arriving at the civil surgeon's office. However, the signature in Part 2 must not be dated until the applicant is in the presence of the doctor.

Part 2: Applicant’s Statement and Signature

The applicant certifies that the information provided is true and correct. Do not sign this until instructed by the civil surgeon. Signing the document prematurely can invalidate the entire exam, requiring a new form and a new fee.

Part 3 and Part 4: Interpreter and Preparer Information

If the applicant used an interpreter to understand the form or a preparer to help fill it out, these sections must be completed and signed by those individuals. If the applicant completed the form independently, these sections are left blank or marked as "N/A" where appropriate.

Part 5 through Part 10: The Civil Surgeon’s Domain

These sections are completed exclusively by the USCIS-designated civil surgeon. They include:

Part 5: Verification of the applicant's identity (usually via passport or driver's license).
Part 6: Summary of the medical examination results, including findings of Class A or Class B medical conditions.
Part 7: The doctor's certification and signature. This is the most critical part for validity.
Part 8: The Civil Surgeon Worksheet, which details the results of specific tests for Tuberculosis (TB), Syphilis, and Gonorrhea.
Part 10: The Vaccination Record. The doctor must cross-reference the applicant’s history with the current CDC requirements for age-appropriate vaccines.

The Medical Examination Process

The I-693 process usually requires two visits to the civil surgeon's office, depending on how quickly lab results are returned.

Initial Consultation

During the first visit, the civil surgeon reviews the applicant’s medical history and existing vaccination records. It is vital to bring any records of immunizations received in the home country. If these records are not in English, a certified translation should be provided. The doctor will determine which laboratory tests are necessary based on the applicant’s age. Common tests include:

Tuberculosis (TB) Testing: USCIS requires an Interferon Gamma Release Assay (IGRA) blood test for applicants aged 2 and older. The traditional TST (skin test) is generally no longer accepted for this purpose. If the IGRA test returns a positive result, a chest X-ray is required to rule out active tuberculosis.
Syphilis (RPR) Testing: Required for applicants aged 18 to 44.
Gonorrhea Testing: Required for applicants aged 18 to 24.

Required Vaccinations

The civil surgeon must ensure the applicant is immunized against several diseases as required by U.S. immigration law. These include:

Mumps, Measles, and Rubella (MMR).
Polio.
Tetanus and Diphtheria Toxoids.
Pertussis.
Haemophilus influenzae type b (Hib).
Hepatitis A and B.
Varicella (Chickenpox).
Influenza (required during the flu season, typically October 1 through March 31).
Pneumococcal disease.
Meningococcal disease.
Rotavirus.

If an applicant lacks immunity or records for these vaccines, the civil surgeon will administer them or provide a referral to a local pharmacy. For vaccines that require multiple doses, only the first dose needs to be completed before the I-693 can be signed, provided the doctor marks "insufficient time interval" for the subsequent doses.

The Physical Examination

A physical exam is mandatory. The doctor will check for physical or mental disorders with associated harmful behavior, as well as evidence of drug abuse or addiction. These findings are summarized in the Class A and Class B condition sections of the form.

Finding a Designated Civil Surgeon

Applicants cannot go to their regular family doctor for an I-693 exam unless that doctor is also a USCIS-designated civil surgeon. To find an authorized doctor, one should use the "Find a Civil Surgeon" tool on the USCIS website.

Cost Considerations

The cost of the I-693 process varies significantly by location and provider. On average, applicants can expect to pay between $200 and $600 for the doctor's administrative fee and physical exam. Laboratory tests and vaccinations are often billed separately.

Insurance Coverage: Many health insurance plans cover the cost of vaccinations as preventive care. However, the physical exam itself and the specialized immigration lab tests are frequently not covered.
Lab Options: Some clinics allow applicants to use third-party labs like Quest Diagnostics or LabCorp, which may be cheaper if the applicant's insurance has a negotiated rate with those facilities.

Validity and Expiration of Form I-693

The validity period of Form I-693 has been subject to change in recent years to reduce the burden on both applicants and the agency. Under current policy, a Form I-693 that is properly completed and signed by a civil surgeon does not expire as long as it was signed on or after November 1, 2023. This "permanent" validity (relative to the pending I-485) is intended to eliminate the need for applicants to undergo repeat medical exams during long processing times.

However, if the medical exam was signed prior to November 1, 2023, it generally retains a two-year validity from the date of the doctor's signature. It is always advisable to submit the I-693 concurrently with the I-485 to avoid delays, though it can be submitted later in response to an RFE or brought to the interview if permitted.

Common Mistakes to Avoid

Opening the Sealed Envelope: For mail-in applications, this is the most frequent error. If the envelope looks tampered with, it will be rejected.
Incomplete Vaccination Records: Failing to provide proof of age-appropriate vaccines or failing to get the first dose of a required series.
Missing Signatures: Ensure the doctor has signed and dated the form, and that the clinic's official stamp is present if required.
Expired Version: Using an old PDF version after the USCIS grace period has ended.
Illegible Handwriting: If filling out by hand, ensure every letter and number is clear. USCIS uses automated systems to scan these forms.

Troubleshooting PDF Issues

If the Form I-693 PDF does not load correctly or shows a "Please Wait" message, this is usually a sign that the browser is trying to use its own PDF viewer rather than Adobe Acrobat.

Solution: Right-click the download link on the USCIS website and select "Save Link As" to download the file directly to the computer. Open the file from the desktop using the Adobe Acrobat application.
Barcode Verification: After printing, check the bottom of the pages. There should be a complex, square or rectangular barcode. If this area is blank or blurred, the print quality is insufficient.

Frequently Asked Questions (FAQ)

What is the difference between a Panel Physician and a Civil Surgeon?

A Panel Physician performs medical examinations for individuals applying for visas outside the United States at a U.S. Embassy or Consulate. A Civil Surgeon is a doctor authorized to perform these exams for individuals already inside the U.S. applying for adjustment of status.

Can I submit Form I-693 after filing my I-485?

Yes. While USCIS recommends concurrent filing to speed up the process, you can wait for a Request for Evidence (RFE) or, in some cases, bring the sealed envelope to your Green Card interview. However, waiting for an RFE will inevitably add several weeks or months to your total processing time.

Does the COVID-19 waiver apply to all ages?

Yes, the January 22, 2025, waiver applies to all applicants regardless of age. The civil surgeon no longer checks for COVID-19 vaccination status for anyone completing Form I-693.

What happens if my TB test is positive?

A positive IGRA test does not mean you will be denied a Green Card. It simply means you have been exposed to the bacteria. You will be required to get a chest X-ray. If the X-ray shows no active disease, the civil surgeon will mark you as having "Latent TB" (Class B), which does not make you inadmissible. You may be advised to seek treatment, but it won't stop your application.

How long does it take to get the completed form?

Typically, the process takes 5 to 7 business days. This timeframe allows for the laboratory to process blood tests for TB, Syphilis, and Gonorrhea. Some clinics offer expedited services for an additional fee if lab results can be returned faster.

Summary

Navigating the Form I-693 PDF requirements is a pivotal step in the U.S. immigration journey. By ensuring the use of the 01/20/25 edition, adhering to the updated vaccination guidelines that now exclude COVID-19, and understanding the nuances of the sealed envelope for online versus mail filing, applicants can significantly reduce the risk of delays. Always prioritize the official USCIS website for the latest form downloads and consult with a designated civil surgeon early in the application process to allow sufficient time for laboratory testing and any necessary immunizations.