Most applicants adjusting status to lawful permanent residence in the United States must complete an immigration medical examination with a USCIS-designated civil surgeon and submit Form I-693, Report of Immigration Medical Examination and Vaccination Record, following the current form instructions. Certain applicants and categories have different medical-exam requirements. People applying for immigrant visas abroad generally see a consular panel physician rather than a USCIS civil surgeon.
What the Immigration Medical Examination Covers
INA §212(a)(1) includes separate grounds involving certain communicable diseases of public health significance, required vaccinations, physical or mental disorders with associated harmful behavior, and drug abuse or addiction. Civil surgeons conduct the examination using the CDC technical instructions; the medical report informs USCIS, which determines immigration admissibility. A civil surgeon does not decide whether a green card is approved.
The list of reportable conditions and required vaccinations can change. Rather than rely on a historical list of illnesses or vaccines, applicants should consult the CDC’s current vaccination instructions. Vaccination requirements depend on age, vaccination history, documented immunity, medical contraindications, and whether a required series can be completed at the examination.
Vaccination Exceptions and Waivers
A missing vaccination does not always require an individual waiver application. When a vaccine is not medically appropriate because of age, a contraindication, insufficient time between doses, or the influenza vaccine being unavailable outside the relevant season, the civil surgeon can document the applicable reason on Form I-693 for a blanket waiver. The applicant ordinarily does not file a separate Form I-601 for that medically documented blanket waiver.
Different rules apply when an applicant objects to vaccination on religious or moral grounds. A qualifying individual waiver generally requires evidence of sincerely held religious beliefs or moral convictions opposing vaccination in all forms, rather than a preference against one particular vaccine. Prior vaccinations do not automatically disqualify an applicant, but the history and explanation are relevant. Such a request ordinarily involves Form I-601 and is adjudicated by USCIS. See the USCIS vaccination-waiver guidance.
Other health-related inadmissibility grounds have distinct requirements and waiver provisions. It is inaccurate to assume that any communicable disease, mental health finding, or incomplete vaccination record can be overcome by simply requesting a waiver. The medical classification, applicable statute, and individual circumstances must be reviewed.
Form I-693 Submission and Civil Surgeon Selection
The civil surgeon must properly complete and sign Form I-693. Follow the current USCIS instructions for when the medical report must accompany Form I-485, how to handle the sealed envelope, and how long the report remains valid for the relevant application. As USCIS clarified in June 2025, an I-693 submitted with a benefit application generally does not remain valid for a new application after the original benefit request is denied or withdrawn. An incomplete report may result in a request for evidence or other adverse action.
Our office has assisted many clients whose medical examinations were performed by USCIS-designated civil surgeons, but we do not select or supervise those physicians. We direct applicants to the official USCIS civil surgeon locator. The physician provides the applicant with the required medical documentation and a copy for personal records. Applicants should not open a sealed Form I-693 envelope that must be submitted to USCIS.
This article originated in 2011; the current-rule explanations above reflect the October 2026 legal review. Check USCIS and CDC guidance when preparing a new filing.