USCIS Immigration Medical Exam (Form I-693): A Complete 2026 Guide for NYC Applicants

For most people, the green card medical exam is the one step in the whole immigration process that no lawyer can do for you. Your attorney can file the petition, assemble the evidence, and argue your case — but the Form I-693 has to be completed by a specific kind of doctor, sealed in a specific kind of envelope, and submitted without a single thing out of place. Get it wrong, and USCIS sends a Request for Evidence (RFE) that can add months to your timeline.

This guide walks through the entire process in plain language: what the exam is, who actually needs it, what happens during the appointment, which vaccines are required, and the avoidable mistakes that delay applications. It's written for applicants across Brooklyn, Queens, and Nassau County — many of whom are doing this for the first time, in a second language, under a deadline.

What is the USCIS immigration medical exam (Form I-693)?

Form I-693 — officially the Report of Immigration Medical Examination and Vaccination Record — is the document USCIS uses to confirm that an immigration applicant is not inadmissible to the United States on public-health grounds. It records the results of a required medical examination and your vaccination history.

The exam can only be performed by a USCIS-designated Civil Surgeon — a physician specifically authorized by U.S. Citizenship and Immigration Services to conduct immigration medical examinations. A regular doctor, even an excellent one, cannot complete Form I-693 unless they hold this federal designation. At RASMED Clinic, Dr. Syed Z. Hussaini, MD holds the Civil Surgeon designation and performs I-693 exams at both our Brooklyn and Valley Stream locations. You can read more about the full process on our immigration physicals page.

Here's the part that surprises people: the Civil Surgeon's job is not to treat you or to decide your immigration case. It's to examine you, document specific findings, administer any missing required vaccines, and seal the completed form. The exam is a screening for conditions of public-health significance — it is not a substitute for primary care.

Who needs to complete Form I-693?

You generally need an I-693 immigration medical exam if you are applying for lawful permanent resident status (a green card) from inside the United States. The most common categories include:

Adjustment-of-status applicants (Form I-485)
Family-based green card petitions
Employment-based green card applicants
Diversity Visa (green card lottery) winners adjusting status
Asylees and refugees adjusting to permanent residence
VAWA self-petitioners
U-visa and T-visa holders adjusting status

Applicants going through consular processing abroad use a panel physician overseas instead of a U.S. Civil Surgeon, so the I-693 generally applies to people adjusting status from within the country. Your immigration attorney or your USCIS notice is the final word on whether the exam is required for your specific case.

What happens during the I-693 exam, step by step

A typical appointment runs 60 to 90 minutes. Knowing the sequence in advance removes most of the anxiety.

1. Physical examination

The Civil Surgeon reviews your general health — heart, lungs, abdomen, lymph nodes, skin, and extremities — and records height, weight, vision, and blood pressure. This is a screening exam, not a head-to-toe diagnostic workup.

2. Tuberculosis (TB) screening

Applicants 2 years and older are screened for tuberculosis, usually with an IGRA blood test (such as QuantiFERON) or a tuberculin skin test. If a result is positive or there's a relevant history, a chest X-ray may be required, and in some cases further evaluation before the form can be completed.

3. Syphilis and gonorrhea screening

A blood test for syphilis is required for applicants 15 and older, and gonorrhea screening is part of current CDC requirements for civil surgeons. Results are documented directly on the form.

4. Vaccination review and administration

The Civil Surgeon reviews your immunization records against the USCIS-required vaccine list and administers anything you're missing, right there in the office. This is the single most common cause of delay — more on it below.

5. Mental health and substance screening

A brief assessment for conditions relevant to USCIS admissibility, including a screening related to drug and alcohol use. This is standard and applies to everyone.

6. Completion and sealing of Form I-693

The Civil Surgeon completes, signs, and seals the form in an official envelope. Do not open it. A I-693 that arrives at USCIS already opened is generally rejected, and you'll have to repeat part of the process.

Which vaccines are required for the immigration medical exam?

USCIS requires proof of immunity (or vaccination) against a defined list of diseases. As of 2026 the required vaccines generally include:

Influenza (seasonal)
Tdap / Td (tetanus, diphtheria, pertussis)
MMR (measles, mumps, rubella)
Varicella (chickenpox)
Hepatitis A and Hepatitis B
Pneumococcal
Meningococcal
Polio
COVID-19 requirements have changed over time — confirm the current rule at your appointment
HPV and rotavirus where age-appropriate

The required list is age-specific — not every applicant needs every vaccine. The most important thing you can do is bring every vaccination record you have, including records from your home country. If you can document prior immunity, you avoid paying for and receiving shots you don't need. Records in another language are fine; bring translations where you can.

How long is Form I-693 valid?

This rule changed, and a lot of older online guides are now wrong. Historically, Form I-693 was valid for two years from the Civil Surgeon's signature. Under updated USCIS policy, a Form I-693 that is properly completed and signed by a civil surgeon on or after November 1, 2023 generally does not expire.

Because USCIS policy can be updated, always confirm the current validity rule for your case with your immigration attorney or the latest USCIS guidance before you file. When in doubt, scheduling your exam reasonably close to your filing date is still sensible.

What to bring to your appointment

Government-issued photo ID or passport (original, not a copy)
Your complete vaccination and immunization records — including from abroad
Your USCIS case number or I-485 receipt notice, if you have one
Records for any chronic medical condition and a list of current medications
Any previous TB test results or chest X-ray reports
Payment — immigration exams are paid out of pocket, since standard health insurance does not cover USCIS-required exams

The mistakes that delay green card applications — and how to avoid them

Opening the sealed envelope. Curiosity is natural, but an opened I-693 is generally invalid. Hand it to USCIS exactly as you received it.
Showing up without vaccine records. Without documentation, the Civil Surgeon may have to administer vaccines you may already be immune to — costing time and money. Track down your records first.
Booking with a doctor who isn't a Civil Surgeon. Only a USCIS-designated Civil Surgeon can complete the form. Confirm the designation before you book.
Timing the exam poorly relative to your filing. Coordinate the date with your attorney so the completed form fits cleanly into your application package.
Language barriers during a medical exam. Misunderstanding a question about your history can create errors on a federal form. Choose a clinic where staff speak your language directly.

Why language matters for the immigration medical exam

An immigration physical is a conversation about your health history conducted on a legal document. If you can describe your symptoms, your past illnesses, and your medications accurately — in your own language — the form is more accurate and the process is smoother. RASMED Clinic's staff are fluent in English, Urdu, Hindi, Punjabi, Spanish, and Hebrew, which matters to the immigrant communities we serve across Brooklyn and Long Island.

Frequently asked questions

How much does an immigration physical cost?

The exam fee covers the Civil Surgeon examination and completion of Form I-693. Vaccines are billed separately and depend on which ones you actually need — another reason to bring your records. Because USCIS-required exams aren't covered by standard insurance, plan to pay out of pocket. Call our office at 718-859-7446 for current pricing.

Can I get the exam and the vaccines done on the same day?

Yes. The Civil Surgeon can administer any missing required vaccines during the same appointment, which is why most applicants complete everything in one visit.

Do I need an appointment, or can I walk in?

We offer same-day and next-day appointments at both locations, and walk-ins are welcome — though booking ahead means we can have your paperwork ready. You can book your I-693 exam online or by phone.

What if my TB test comes back positive?

A positive TB screen doesn't automatically affect your immigration case, but it does require follow-up — typically a chest X-ray and a medical evaluation — before the Civil Surgeon can finalize the form. Starting early gives you time to complete any additional steps without holding up your filing.

Booking your I-693 exam in Brooklyn or Valley Stream

RASMED Clinic is a USCIS-designated Civil Surgeon practice with two locations: our Brooklyn office at 1199 Ocean Avenue near the Q train, and our Valley Stream office at 139 N Central Avenue in Nassau County. Dr. Syed Z. Hussaini, MD — dual board-certified in Family Medicine and Addiction Medicine and a designated Civil Surgeon — performs I-693 exams at both, with same-day availability and multilingual staff.

We also handle other documentation and occupational exams families often need, including DOT physical exams for commercial drivers and confidential Suboxone treatment for opioid use disorder. And if you're new to the area and still choosing a doctor, our guide on how to choose a primary care doctor in Brooklyn is a good place to start.

Ready to begin? Book your immigration physical online, call 718-859-7446, or read the full I-693 service overview. More questions are answered on our FAQ page.

Medically reviewed by Dr. Syed Z. Hussaini, MD — USCIS-designated Civil Surgeon and founding physician at RASMED Clinic, dual board-certified in Family Medicine (ABFM) and Addiction Medicine (ABAM). This article is for general educational purposes and is not a substitute for individual medical or legal advice. Immigration policy changes; confirm current requirements with USCIS or a licensed immigration attorney.