Understanding the Immigration Medical Exam
The immigration medical exam is a required health screening for most applicants seeking a green card (permanent residency) in the United States. Its purpose is to identify any health conditions that could make an applicant inadmissible under U.S. immigration law, such as certain communicable diseases.
The exam must be performed by a USCIS-designated civil surgeon — a physician authorized by U.S. Citizenship and Immigration Services to conduct these examinations. The results are recorded on Form I-693, the official Report of Medical Examination and Vaccination Record, which is then sealed and submitted to USCIS as part of your green card application.
What You Need for Your Appointment
Gathering the right documents before your immigration medical exam saves time and reduces stress. Having everything ready also helps the civil surgeon complete Form I-693 accurately and avoid delays.
Identification and Vaccination Records
Bring a valid government-issued photo ID such as a passport or driver's license. For children under 14, a birth certificate showing the child's name, date and place of birth, and parent's full names is acceptable. Complete vaccination records are also required. If you cannot find your records, the civil surgeon can discuss options like blood antibody titers to verify immunity.
Medical History and Supporting Documents
Bring a written list of any current medications you take. If you have been previously treated for tuberculosis or syphilis, include a certificate of clearance or a doctor's letter confirming successful treatment and recovery. These documents help the surgeon accurately assess your health history.
Form I-693 and Interview Letter
Applicants in the US must bring a completed but unsigned copy of Form I-693 (the latest edition from the USCIS website). Applicants abroad need the green card interview appointment letter from the National Visa Center, as the panel physician will not perform the exam without it.
Payment and Insurance Details
The immigration medical exam fee is set by the provider and is typically not covered by health insurance. Bring your health insurance card and payment for the exam fee. The civil surgeon at Jana HealthCare's Brooklyn office can confirm the cost at the time of scheduling, so you know what to expect.
Required Tests and Vaccinations
The immigration medical exam includes several specific laboratory tests and a thorough review of your vaccination history. The tests you will undergo depend on your age, and the civil surgeon will follow CDC guidelines to ensure you meet all requirements.
Age-Based Laboratory Tests
A tuberculosis (TB) blood test called the interferon gamma release assay (IGRA) is required for all applicants aged 2 and older. This test screens for latent TB infection. If the IGRA result is positive, the civil surgeon will order a chest X-ray to rule out active TB disease. Applicants from countries with high TB rates may need the X-ray regardless of the blood test result.
For syphilis, a blood test is required for applicants aged 18 through 44. For gonorrhea, a urine or swab test (NAAT) is required for applicants aged 18 through 24. Applicants under 18 are generally not tested for these infections unless there is a clinical reason to do so.
Vaccination Requirements
The civil surgeon will review your vaccination records and compare them against the CDC's age-based immunization schedule for immigrants. Missing vaccines must be administered during the exam process or shortly after. Required vaccines for most adults include:
- MMR (measles, mumps, rubella)
- Tdap (tetanus, diphtheria, pertussis)
- Polio (IPV)
- Hepatitis B
- Varicella (chickenpox)
- Influenza (seasonal, when in season)
Infants and children have additional requirements such as DTaP, hepatitis A, rotavirus, Hib, pneumococcal, and meningococcal vaccines. If you cannot provide vaccination records, the civil surgeon may order blood titer tests to confirm immunity, or administer catch-up vaccines.
When you visit Jana HealthCare, a USCIS-designated civil surgeon will perform all required lab work on site, so you do not need to arrange separate appointments for blood work or X-rays. The entire testing process is managed in one place, and the civil surgeon reviews all results before completing and sealing your Form I-693.
What Is Not Routinely Tested
There is no automatic drug screening for all applicants. The civil surgeon will ask about your history of drug and alcohol use, and will order testing only if concerning patterns emerge during the history review or physical exam. As of January 2025, the COVID-19 vaccination is no longer required for immigration purposes.
What Happens During the Exam
Your immigration medical exam begins with a detailed medical history review. The civil surgeon will ask about past illnesses, surgeries, hospitalizations, and any ongoing treatments. This is also when you present your vaccination records for review. At Jana HealthCare, we take the time to understand your full health background to ensure nothing is overlooked.
Physical and Mental Health Evaluation
The physical exam is a head-to-toe assessment that includes checking your heart, lungs, eyes, ears, abdomen, skin, and extremities. The civil surgeon will also evaluate your general neurological function. This portion is thorough but generally straightforward for healthy applicants.
A mental health assessment is conducted to identify any condition that could pose a risk of harmful behavior. The doctor will evaluate your intelligence, thought processes, mood, and judgment. If you have a history of mental illness or harmful behavior, you should bring documentation from your treating physician outlining your diagnosis, treatment, and prognosis.
Drug and Alcohol Screening
The civil surgeon will ask about your current and past use of drugs and alcohol. Routine drug testing is not performed on every applicant. The doctor may order a drug or alcohol test only if your history or the clinical interview raises a concern about current abuse or addiction.
Required Lab Tests and Vaccinations
Tuberculosis. Applicants aged 2 and older must undergo an IGRA blood test for TB screening. A chest X-ray is needed only if the blood test is positive or if symptoms suggest active infection.
Syphilis and Gonorrhea. A syphilis blood test is required for applicants aged 18 to 44. Gonorrhea testing, usually via a urine test, is required for applicants aged 18 to 24.
Vaccinations. The civil surgeon will check your records against CDC guidelines. Missing age-appropriate vaccines, such as MMR, Tdap, polio, hepatitis B, and varicella, can be administered during the visit.
After all tests are completed, the civil surgeon signs Form I-693 and places it in a sealed envelope marked for USCIS use only. You must submit this envelope unopened with your immigration application.
Timeline and Duration
The initial visit typically lasts 30 to 60 minutes. This covers the history review, physical exam, lab draws, and any needed vaccinations. A follow-up visit is often required to review lab results and pick up the sealed Form I-693, which is usually ready within a few business days.
Understanding Costs and Validity
The cost of the I-693 immigration medical exam is set by the civil surgeon, not by USCIS, and varies by provider and location. Typical fees range from $100 to $500, with $200 being common. At Jana HealthCare, the total varies based on each patient's needs, including required lab tests and vaccinations. Our team provides a clear fee breakdown during consultation. The expense covers the physical exam, blood work, tuberculosis screening, and any needed immunizations.
Health insurance rarely covers the exam because it is not considered a medical necessity. Applicants should confirm payment policies when scheduling an appointment.
Exam Validity and Submission Timing
Form I-693 is valid for 12 months from the date the civil surgeon signs it, per USCIS guidelines. However, the form must be submitted within 60 days of the signature to be considered valid, or a new exam may be required. If Form I-485 (Application to Register Permanent Residence) is filed within that one-year window, the medical exam generally remains valid while the application is pending, even if adjudication takes longer.
Under current policy, a properly signed Form I-693 stays valid as long as the associated I-485 case remains open and has not been denied or withdrawn. The validity is tied to that specific pending application and cannot be transferred to a new one. To avoid delays, plan to file your application before the one-year mark and check current USCIS guidance for any policy changes. Schedule an appointment at Jana HealthCare to receive a full cost estimate and ensure your paperwork is handled correctly.
After the Exam and Possible Outcomes
Once your immigration medical exam is complete, the civil surgeon will document all findings on Form I-693. You will receive the form in a sealed envelope that must remain unopened. Opening the envelope voids the document and USCIS will not accept it. At janahealthcare.com, the civil surgeon counsels each patient on the proper handling of the sealed results to avoid submission errors. This process is part of a holistic approach to your health, ensuring that your medical care aligns with your overall wellness goals.
Applicants within the United States must submit the sealed envelope with their green card application (Form I-485) at the same time. As of December 2, 2024, failure to include the medical exam results with the initial filing may lead to rejection of the entire application. For applicants abroad, the panel physician will either hand over the sealed envelope or send it directly to the U.S. embassy or consulate.
Reasons for Inadmissibility
The exam identifies conditions that may make an applicant inadmissible under the Immigration and Nationality Act. These include active, untreated communicable diseases such as tuberculosis, syphilis, gonorrhea, and leprosy. A physical or mental disorder associated with harmful behavior, current drug or alcohol abuse, and a history of substance addiction can also lead to a denial.
Conditions That Do Not Affect Admissibility
Many health conditions do not disqualify an applicant. Having a chronic but well-managed disease like diabetes or heart disease, being HIV-positive, or having a cold will not bar admission. Previously cured communicable diseases are also not a concern. The civil surgeon at janahealthcare.com helps patients understand which pre-existing conditions need documentation and which are simply noted on the form without affecting the application. Maintaining overall wellness through a balanced lifestyle, including proper nutrition, exercise, and mental health care, can support your health during the immigration process. The civil surgeon can provide guidance on holistic health practices that complement your medical care.
Class A vs Class B Conditions
Class A condition. A communicable disease of public health significance, such as active tuberculosis or untreated syphilis, that may render the applicant inadmissible. A waiver may be available in some cases.
Class B condition. A noncommunicable condition or a past illness that has been resolved, such as inactive TB or a stable mental health issue. It does not make the applicant inadmissible but may require follow-up with a health department after arrival.
For those interested in aesthetic enhancement, the civil surgeon can offer referrals for cosmetic procedures that are safe and aligned with your health needs.
How to Challenge a Denial
If a health-related condition leads to a denial, applicants have options. Providing proof of successful treatment for prior communicable diseases, documentation of controlled substance abuse or mental illness, and a letter from a regular doctor explaining how a serious condition is managed can all strengthen a case. For certain conditions, applying for a waiver of inadmissibility from USCIS is possible. The civil surgeon at janahealthcare.com can review what documentation you have and advise on next steps tailored to your situation. Additionally, the exam can be a starting point for optimizing your health, as the civil surgeon can connect you with resources for ongoing wellness and disease prevention.
At janahealthcare.com, we integrate medical knowledge with holistic wellness and aesthetic enhancement to provide personalized care that optimizes your health and supports your immigration journey.
Final Checklist and Next Steps
A smooth immigration medical exam comes down to preparation and timing. Start by scheduling your appointment with a USCIS-designated civil surgeon 4 to 6 weeks before you plan to file Form I-485.
Bring a valid government-issued photo ID, complete vaccination records, any relevant medical history, and payment for the exam fee. After the civil surgeon signs Form I-693, submit the sealed envelope with your green card application at the same time. The team at Jana HealthCare recommends keeping a personal copy of the completed form for your records before the envelope is sealed.
