Form I-693, formally known as the Report of Immigration Medical Examination and Vaccination Record, is a critical document for anyone applying for lawful permanent resident status (a Green Card) in the United States. Its primary function is to establish that an applicant is not inadmissible to the U.S. based on health-related grounds. Whether you are filing through family-based or employment-based categories, ensuring the Form I-693 is completed accurately and submitted according to the latest USCIS regulations is essential for avoiding Requests for Evidence (RFE) or application denials.

Where to Download the Latest Form I-693 PDF

The only reliable source for the Form I-693 PDF is the official United States Citizenship and Immigration Services (USCIS) website. Applicants should avoid downloading this form from third-party sites, as these platforms often host outdated versions that USCIS will reject.

The current edition of Form I-693 is dated 01/20/25. USCIS maintains a specific grace period policy: if a civil surgeon signs the form on or before July 2, 2025, the 03/09/23 edition may still be used. However, for any medical examinations signed on or after July 3, 2025, only the 01/20/25 edition will be accepted. The edition date can always be found at the bottom left or right corner of each page of the form. When printing the PDF, ensure that the edition date and page numbers are clearly visible on every page.

Major Policy Changes for Simultaneous Filing in 2025

Starting December 2, 2024, USCIS implemented a significant procedural update regarding how Form I-693 is submitted. In previous years, many applicants would wait for an RFE to send their medical results or bring the sealed envelope to their interview. Under the new guidance, most applicants filing Form I-485 (Adjustment of Status) must submit their completed Form I-693 simultaneously with their initial application package.

Failure to include the Form I-693 at the time of filing the I-485 may lead to the rejection of the entire application package or significant delays in processing. This change aims to streamline the adjudication process, allowing USCIS officers to make decisions faster without pausing to wait for medical records.

Essential Components of Form I-693

Form I-693 is a multi-page document divided into sections intended for the applicant, the interpreter (if used), and the USCIS-designated civil surgeon.

Part 1: Information About You

The applicant is responsible for completing Part 1. This section requires standard biographical information, including full name, physical address, date of birth, and Alien Registration Number (A-Number) if applicable. It is vital to use black ink and ensure that all information matches the details provided in the Form I-485.

Part 2: Applicant's Statement and Signature

This is a critical area where mistakes frequently occur. While the applicant must fill out the statement regarding their understanding of the form, they must not sign the document until instructed to do so by the civil surgeon during the medical examination. A signature dated before the medical exam or performed outside the presence of the authorized doctor can invalidate the entire form.

Parts 4 through 10: The Civil Surgeon's Responsibility

The remainder of the form must be completed by a USCIS-designated civil surgeon. This includes the results of the physical exam, screening for communicable diseases, and the comprehensive vaccination record.

Finding a USCIS-Designated Civil Surgeon

A regular primary care physician or a doctor chosen at random cannot complete Form I-693. Only "civil surgeons" specifically designated by USCIS have the authority to perform these examinations. To find an authorized provider, applicants must use the official "Find a Civil Surgeon" tool on the USCIS website.

When scheduling an appointment, it is advisable to confirm the current fees. USCIS does not set the price for the medical exam; fees are determined by the individual medical practice and can vary significantly, often ranging from $200 to $600 or more, excluding the cost of required vaccinations or follow-up tests.

Medical Examination and Testing Requirements

The medical exam is not a general physical but a targeted screening for specific conditions that affect public health. The civil surgeon will check for:

  • Communicable Diseases: This includes testing for Tuberculosis (TB), Syphilis, and Gonorrhea. For TB, USCIS now requires the Interferon-Gamma Release Assay (IGRA) blood test for most applicants, replacing the older Tuberculin Skin Test (TST) in many contexts due to its higher accuracy.
  • Physical and Mental Disorders: The doctor evaluates whether the applicant has any disorder associated with harmful behavior.
  • Drug Addiction and Abuse: A clinical evaluation is conducted to determine if the applicant is currently a drug abuser or addict.
  • Vaccination History: Applicants must show proof of having received required vaccines, including those for Mumps, Measles, Rubella (MMR), Polio, Tetanus and Diphtheria Toxoids, Pertussis, Haemophilus influenzae type B (Hib), and Hepatitis B.

Starting in late 2021, the COVID-19 vaccination became a mandatory requirement for the immigration medical examination. Applicants must complete the entire vaccine series and provide documentation to the civil surgeon.

The Sealed Envelope Rule

The handling of the completed Form I-693 is governed by strict security protocols to prevent tampering.

For Paper Filing (By Mail)

Once the exam is complete and the form is filled out, the civil surgeon will place the original Form I-693 and any supporting documents into an envelope and seal it. The applicant will receive this sealed envelope. It is the "Golden Rule" of immigration medicals: Do not open the envelope. If the seal is broken or the envelope appears tampered with, USCIS will reject the form. The applicant must submit the envelope, still sealed, along with their I-485 application package.

For Online Filing

With the introduction of online filing for certain I-485 categories, the process has changed slightly. If you are filing your adjustment of status online, you are actually required to open the sealed envelope provided by the civil surgeon so that you can scan and upload the Form I-693 as part of your digital application. However, you must keep the original paper form and the opened envelope in a safe place. USCIS may request the original physical copy during an interview or as part of a further evidence request.

Validity and Expiration of Form I-693

Understanding the timeline of Form I-693 is crucial for successful filing.

  1. Signature Validity: The Form I-693 is generally valid for two years from the date the civil surgeon signs it.
  2. Filing Window: Under the latest guidelines, once the form is submitted to USCIS, it typically remains valid for the duration of the time the I-485 application is pending, provided it was valid at the time of filing.

This "indefinite validity" while an application is pending is a major relief for applicants facing long backlogs in Green Card processing, as it eliminates the need to undergo multiple medical exams if the case takes several years to resolve.

Common Reasons for Rejection

Avoiding simple errors can save months of processing time. Common reasons USCIS rejects Form I-693 include:

  • Expired Edition: Using a version of the PDF that is no longer accepted.
  • Unauthorized Doctor: Having the form signed by a doctor who is not a USCIS-designated civil surgeon.
  • Missing Signatures: Either the applicant or the doctor forgetting to sign and date the form in the correct sections.
  • Incomplete Testing: Failure to perform the required Syphilis or TB tests based on the applicant's age or medical history.
  • Opened Envelope: Breaking the seal on the envelope before mailing it to USCIS (for paper filers).
  • Missing Vaccine Records: Failing to provide evidence of all required immunizations or a valid medical waiver.

Frequently Asked Questions

Can I use my health insurance for the I-693 exam?

Most health insurance plans do not cover the cost of an "immigration physical" because it is considered an administrative requirement rather than a medically necessary procedure. However, insurance may cover the cost of the required vaccinations if they are administered by your primary care physician before your appointment with the civil surgeon.

What should I bring to the medical exam appointment?

You should bring a valid government-issued photo ID (such as a passport), your vaccination records, any previous TB test results, a list of current medications, and the Form I-693 PDF with Part 1 already filled out.

What happens if I have a Class A medical condition?

A Class A medical condition (such as active TB or a specific communicable disease) makes an applicant inadmissible. In such cases, the applicant must undergo treatment and be cleared before the civil surgeon can sign off on the Form I-693. In some instances, a waiver may be available via Form I-601.

How long does the medical exam process take?

The initial appointment usually takes about an hour, but the entire process often takes 7 to 10 days. This is because the civil surgeon must wait for laboratory results (such as blood tests for Syphilis and the IGRA test for TB) to return before they can finalize and sign the form.

Conclusion

Successfully navigating the Form I-693 process requires attention to detail and a clear understanding of current USCIS timelines. By downloading the correct 2025 version of the PDF, choosing a designated civil surgeon, and adhering to the new simultaneous filing requirements, applicants can ensure their medical records support rather than hinder their journey toward a Green Card. Remember that the medical exam is a snapshot of your health at a specific moment; keeping your vaccination records organized and staying informed about the latest COVID-19 and TB testing protocols is the best way to avoid unnecessary delays in your immigration journey.