Medical Examination for Green Card Applicants — The 2026 Guide

Published on: Thu May 07 2026

You’re almost there. Your I-485 is filed, your priority date is current, and the only thing standing between you and your green card is a single doctor’s visit. Then the form arrives — Form I-693, Report of Immigration Medical Examination and Vaccination Record — and suddenly you’re wondering what tests you actually need, which doctor can sign it, and whether one missing vaccine can derail months of waiting.

The good news: the green card medical exam is one of the more predictable parts of the process. The bad news: small mistakes — the wrong doctor, an expired form, a missed vaccine — can trigger an RFE or push your case back six months. This guide walks you through exactly what to expect, how to prepare, and how to keep your case moving.

Why USCIS Requires a Medical Exam

The Public Health Standard

Every applicant for adjustment of status or an immigrant visa abroad must prove they are not inadmissible on health-related grounds under INA § 212(a)(1). In plain English: USCIS wants to confirm you don’t have a condition that endangers public health, that you’re up to date on required vaccinations, and that you don’t have a substance use disorder or mental disorder with associated harmful behavior.

This applies to every green card category — EB-1, EB-2 NIW, EB-3, EB-5, marriage-based, family-based, K-1 fiancé visas, and refugee/asylee adjustments. Children, spouses, and derivative beneficiaries all need their own exam.

What Could Make You Inadmissible

Only a short list of findings actually causes problems:

Class A communicable diseases of public health significance (active TB, untreated syphilis, gonorrhea, leprosy)
Failure to show vaccination for required diseases without a valid waiver
Physical or mental disorder with harmful behavior (very rare; usually involves a documented history)
Drug abuse or drug addiction as defined under federal law

Most applicants — including those with chronic conditions like diabetes, hypertension, or treated mental health diagnoses — pass without issue. The exam is a screening, not a fitness test.

Who Can Perform the Exam

Civil Surgeons (Inside the U.S.)

If you’re filing Form I-485 in the United States, your exam must be done by a USCIS-designated civil surgeon. Your family doctor cannot sign the I-693 unless they happen to hold this designation.

To find one:

Go to uscis.gov/findadoctor
Enter your ZIP code
Filter for civil surgeons within driving distance

You’ll typically see urgent-care chains, immigration-focused clinics, and some hospital systems. Costs in 2026 generally range from $200 to $600, depending on city and which vaccines you still need.

Panel Physicians (Outside the U.S.)

If you’re going through consular processing abroad, you’ll see a panel physician designated by the U.S. embassy or consulate handling your case. The list is published on the embassy’s website under “Immigrant Visa Medical Examination.”

Panel physicians submit the exam directly to the consulate. You don’t carry the sealed envelope yourself — but bring a copy of your appointment letter, passport, and visa case number.

What to Avoid

Telehealth exams — not allowed for the I-693
Walk-in clinics that aren’t on the USCIS list — the form will be rejected
Out-of-date civil surgeon credentials — verify the doctor is still designated on the day you book

What Happens at the Exam

Medical History Review

The civil surgeon will go through a written health questionnaire and ask about:

Past surgeries and hospitalizations
Current medications (bring the bottles or a printed list)
Mental health history and any prior substance use treatment
Immunization history — bring all records you have

If you’ve ever been treated for TB, syphilis, or any reportable communicable disease, bring documentation of treatment completion. This is the single most important piece of paperwork you can bring with you.

Physical Examination

The physical is a standard once-over:

Height, weight, blood pressure, pulse
Eyes, ears, nose, throat
Heart and lung auscultation
Abdomen, lymph nodes, skin
Brief neurological and mental status assessment

It usually takes 10 to 20 minutes. You’ll undress to underwear and put on a gown.

Required Tests

Two tests are mandatory for almost everyone:

Tuberculosis screening — for applicants 2 years and older, this is now done with an Interferon-Gamma Release Assay (IGRA) blood test (such as QuantiFERON-TB Gold). The older skin test is no longer accepted in most circumstances.
Syphilis blood test — required for applicants 15 years and older.
Gonorrhea testing — required for applicants 15 years and older as of the updated 2024 guidance.

If your IGRA comes back positive, you’ll need a chest X-ray to rule out active TB. A positive IGRA with a clean X-ray means latent TB — not a barrier, but you’ll likely be advised to follow up with treatment.

The Vaccine Requirement

What’s Required in 2026

You must show proof of vaccination — or receive vaccines at the appointment — for the diseases on the CDC’s Technical Instructions list. As of 2026, that includes:

MMR (measles, mumps, rubella)
Tdap or Td
Polio
Varicella (chickenpox)
Hepatitis A and Hepatitis B
Influenza (seasonal — only required during flu season, roughly October through March)
Pneumococcal (age-appropriate)
Rotavirus (age-appropriate, infants only)
Hib (age-appropriate, infants only)
Meningococcal (age-appropriate)
COVID-19 — removed from the required list in 2025, no longer needed for the I-693

Bring every vaccination record you can find — pediatric records, employer occupational health records, study-abroad clinic records. Each documented dose is a vaccine you don’t have to repeat or pay for.

Blanket Waivers and Exemptions

If a vaccine isn’t medically appropriate, isn’t routinely available, or you object on religious or moral grounds, you can apply for a waiver. Religious waivers require a separate Form I-601 filing with supporting evidence. Medical contraindications are noted directly on the I-693 by the civil surgeon — no separate form needed.

Form I-693: Filing It Correctly

Validity Period

Here’s the rule that catches most applicants: as of the 2024 policy update, a properly completed I-693 is valid indefinitely — as long as the civil surgeon signed it no more than 60 days before you filed (or are filing) your I-485. If your I-485 is already pending, the I-693 has no expiration once submitted.

This is a meaningful change from the old “two-year rule.” Still, USCIS recommends you submit the I-693 with your I-485 whenever possible to avoid an RFE down the road.

How to Submit

You have three options:

Submit with your I-485 package (recommended)
Submit in response to an RFE — you’ll get a deadline and instructions
Bring it to your I-485 interview in a sealed envelope

The civil surgeon will hand you the form in a sealed envelope with their signature across the seal. Do not open it. USCIS will reject any I-693 that has been opened.

Common Mistakes That Trigger RFEs

Form filled out in pencil or with correction fluid
Missing civil surgeon signature or date
Vaccine record incomplete (blanks instead of “not medically appropriate”)
Sealed envelope opened before submission
Civil surgeon designation lapsed between exam and filing

Special Situations

Applicants With Chronic Conditions

Diabetes, hypertension, asthma, depression on medication, ADHD, prior cancer treatment — none of these are inadmissible. Bring your specialist letters and current medication list. The civil surgeon will note them and move on.

Pregnancy

Pregnant applicants can complete the exam. Live vaccines like MMR and varicella are postponed until after delivery and noted as “not medically appropriate at this time.” This does not trigger inadmissibility.

History of Mental Health or Substance Use

A past diagnosis isn’t disqualifying. What USCIS looks at is current behavior and any history of harm to self or others. Bring treatment records, especially documentation of completed treatment programs and periods of stability.

Children and Derivative Beneficiaries

Every applicant — including infants — needs their own I-693. Pediatric records often satisfy most of the vaccine requirements. The IGRA TB test is required starting at age 2.

What to Do Next

You’re closer than you think. Here’s the practical sequence:

Find a civil surgeon at uscis.gov/findadoctor and book 4–6 weeks before you plan to file (or respond to an RFE).
Gather vaccine records from every doctor, school, and clinic you can remember.
Bring your passport, government ID, and current medications to the appointment.
Do not open the sealed envelope. Submit it directly with your I-485 or RFE response.
Keep a copy of your unsealed I-693 (the doctor will provide one) for your own records.

The medical exam is a checkpoint, not a hurdle. With the right doctor, the right paperwork, and a little preparation, you’ll be in and out in a single visit — and one giant step closer to your green card.