If you’re applying for a Green Card, you need a USCIS medical exam conducted by a designated civil surgeon. This exam checks for health issues that could impact your immigration status, such as communicable diseases or missing vaccinations. The results are recorded on Form I-693, which must be sealed and submitted to USCIS. Only doctors authorized by USCIS can perform these exams.
Here’s what to know:
- Who is a Civil Surgeon? A licensed M.D. or D.O. approved by USCIS to conduct immigration medical exams.
- Why is this needed? To ensure applicants meet public health and vaccination requirements.
- What happens during the exam? Medical history review, physical exam, lab tests for TB, syphilis, and gonorrhea, and vaccination checks.
- Key document: Form I-693 must be completed, signed, and sealed by the civil surgeon.
- Deadlines: As of December 2, 2024, Form I-693 must accompany Form I-485 applications.
Proper preparation – like bringing vaccination records and ID – can prevent delays. Costs range from $200–$500, with additional fees for vaccines. Always confirm the doctor’s USCIS designation before scheduling.
What Civil Surgeons Do During the Medical Exam
Medical History Review and Physical Exam
During the medical exam, the civil surgeon thoroughly reviews your health history. This includes details about past hospitalizations, significant illnesses, and any conditions that affected your overall health or daily functioning. They’ll also ask about mental health history, substance use (including alcohol and psychoactive drugs), and behavioral patterns. The physical exam itself covers major body systems like the heart, lungs, abdomen, eyes, ears, extremities, lymph nodes, and skin. Additionally, the surgeon assesses mental status, evaluating areas such as cognition, judgment, emotional state, and behavior.
After the history and physical exam, the surgeon performs specific tests and screenings to ensure compliance with health standards.
Required Tests and Screenings
These screenings are designed to meet USCIS health requirements. The tests include:
- Tuberculosis (TB) – A positive result leads to a follow-up chest X-ray.
- Syphilis and gonorrhea
- Hansen’s disease (leprosy)
- Drug use or addiction
- Physical or mental disorders associated with harmful behavior
It’s worth noting that HIV testing is no longer part of the exam, as it was removed from the required screenings on January 4, 2010.
Once these tests are completed, the surgeon examines your vaccination records.
Vaccination Review and Administration
The surgeon ensures you are up to date on vaccinations for 15 preventable diseases, such as measles, mumps, rubella, hepatitis A and B, varicella, polio, and influenza (if the exam happens during flu season). Accepted vaccination records must include the exact month, day, and year each dose was given, verified through personal health records or a doctor’s documentation. In some cases, lab tests (titers) can confirm immunity for vaccines like measles, mumps, rubella, hepatitis A and B, varicella, and polio if records are unavailable. Missing vaccinations must be administered during the exam unless an exemption applies.
The results from these evaluations help classify any medical conditions.
Class A and Class B Medical Conditions
Your health history, test results, and vaccination status determine whether you have a Class A or Class B medical condition. Class A conditions include communicable diseases of public health importance, drug addiction, mental disorders with harmful behavior, or failure to provide proof of required vaccinations. These conditions make a person inadmissible. On the other hand, Class B conditions are serious or chronic health issues that don’t prevent admissibility but are documented because they may impact the applicant’s ability to work, attend school, or care for themselves, or may require substantial medical attention in the future. While a Class A condition can stop your application, a Class B condition is simply recorded without affecting your eligibility.
"The civil surgeon’s primary role is to perform immigration medical examinations to assess whether aliens have any of the following medical conditions that could result in their inadmissibility: Communicable disease of public health significance; Failure to show proof of required vaccinations… Physical or mental disorder with associated harmful behavior; and Drug abuse or addiction." – USCIS
If the civil surgeon cannot make a definitive diagnosis, they must refer you to a specialist for further evaluation. However, the civil surgeon is still responsible for completing Form I-693 once all results are available.
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Completing and Handling Form I-693
How Civil Surgeons Fill Out Form I-693
The process begins with the civil surgeon verifying your identity using a government-issued photo ID. After confirming your identity, you’ll sign Part 1 of the form, which serves as your consent for the medical examination and confirms the accuracy of the information you’ve provided.
The civil surgeon will then document your complete medical history, the results of your exam, any required tests, and your vaccination history. This includes noting any vaccines administered during your visit or waivers that apply. If a referral is needed, the surgeon cannot sign the form until they’ve reviewed the referral report and ensured all required treatments are complete. Importantly, the surgeon’s signature must be original and handwritten – stamps or photocopies are not acceptable.
Once all sections of the form are completed and signed, the next step is preparing it for submission.
Sealing and Submitting Form I-693
After completing the form, the civil surgeon seals Form I-693 along with any supporting documents in an envelope. This sealed envelope is critical for submission, and you’ll also receive a copy of your completed vaccination record (Part 10) for your personal files.
"Do not accept the Form I-693 if it is not in a sealed envelope. You (not the civil surgeon) must submit your Form I-693 to USCIS." – USCIS
If you’re mailing Form I-485, do not break the seal on the envelope. However, if you’re filing Form I-485 online, you’ll need to open the envelope to upload the document. Be sure to keep both the original form and the envelope until a final decision is made.
Keep in mind that Form I-693 is valid for two years from the date the civil surgeon signs it, regardless of when you submit your green card application.
Civil Surgeon’s Role vs. USCIS Decision-Making
While the civil surgeon plays a key role in documenting your medical information, it’s important to understand that they are not involved in deciding whether you qualify for status adjustment. Their role is strictly to report your medical findings.
"The civil surgeon is not responsible for determining whether an applicant is actually eligible to adjust their status; that determination is made by the DHS officer after reviewing all records, including the report of the medical examination." – CDC
Even if a Class A condition is noted in your medical report, the final decision on how this impacts your application lies with a USCIS officer, not the civil surgeon.
Qualifications and Standards for Civil Surgeons
How Physicians Become Designated Civil Surgeons
To perform immigration medical exams, a physician must be a licensed M.D. (Doctor of Medicine) or D.O. (Doctor of Osteopathic Medicine) with a current, active, and unrestricted medical license in the state where they will conduct these exams.
Physicians seeking this designation must submit Form I-910, Application for Civil Surgeon Designation, to USCIS. Once approved, they are required to register with eMedical, the electronic system for submitting exam results. Failure to register with eMedical can lead to the revocation of their designation.
Some physicians, such as U.S. Public Health Service officers and military doctors working at Military Treatment Facilities, receive automatic designations without needing to file Form I-910.
Compliance and Professional Standards
Civil surgeons must adhere to strict professional guidelines after receiving their designation. Every exam must comply with the CDC’s Technical Instructions, which provide detailed steps for conducting medical history reviews, physical exams, and screenings for conditions like tuberculosis, syphilis, and gonorrhea. Staying current with these instructions is the responsibility of the civil surgeon.
Maintaining an active and unrestricted medical license is critical. Physicians are required to notify USCIS within 15 days of any disciplinary actions, changes to their license status, or updates to their contact information. USCIS enforces compliance rigorously:
"If a civil surgeon does not follow the Technical Instructions, we may revoke the civil surgeon’s designation. USCIS may also revoke designation if the civil surgeon engages in fraud or unprofessional or unethical conduct." – USCIS
Another important detail for applicants: civil surgeons must use the current version of Form I-693. Submitting an outdated form could lead to the rejection of an application. These measures ensure that only qualified and compliant physicians handle immigration medical exams.
Scope and Limits of Civil Surgeon Services
Understanding what civil surgeons can and cannot do is equally important. Their role is limited to conducting immigration medical exams. They are not responsible for providing ongoing primary care or determining an applicant’s eligibility for a green card.
All exams must be conducted in person, as telemedicine is not allowed for immigration medical evaluations under CDC guidelines. This means applicants must visit the civil surgeon’s office, a key detail to consider when scheduling an exam. These strict rules and clearly defined responsibilities align with USCIS’s broader framework for immigration medical exams.
Interview with a USCIS Civil Surgeon – Everything You Wanted to Know About the I-693 Medical Exam
What Applicants Can Expect From the Exam Process
USCIS Civil Surgeon Medical Exam: Step-by-Step Process
Documents to Bring to the Medical Exam
Preparation is key when attending your civil surgeon appointment. You’ll need to bring a valid government-issued photo ID (like a passport or driver’s license), complete vaccination records (translated into English if necessary), and a detailed list of current medications with dosages. Additionally, check with the civil surgeon’s office to see if you need to bring a printed copy of Form I-693. Some offices provide this form, while others may require you to download and print it beforehand.
Keep in mind that most health insurance plans don’t cover the cost of immigration medical exams. Fees for these exams typically range from $200 to $500, with additional vaccination costs running between $50 and $200 per series.
Once you have all the required documents ready, the exam process will proceed in a structured manner, as outlined below.
Exam Steps and Timeline
The process begins with a check-in, followed by a thorough physical and mental health evaluation and necessary lab tests. These include a mandatory TB test for applicants aged 2 and older, and STD screenings for those aged 15 and up. The physical exam assesses key areas such as vital signs, vision, hearing, heart, and lungs.
After completing the physical exam and lab work, the civil surgeon will review your vaccination history and administer any required vaccines you’re missing. Once your lab results are available, the civil surgeon will finalize Form I-693 and seal it in an envelope. It is important that this envelope remains unopened – any signs of tampering could result in rejection by USCIS. Typically, the sealed form is ready within three business days after lab results are processed.
It’s worth noting that some civil surgeons may have wait times of two to four weeks, so scheduling your appointment early in the green card process is a smart move.
Civil Surgeon Services in Los Angeles County
For applicants in Los Angeles County, USCIS Immigration Medical Exam Specialists simplify this process with both standard and expedited services. Led by Dr. Asher Ram, the clinic offers standard pricing at $350, with results available in 7–9 days, or an expedited option for $475, delivering results in 3–5 days.
Both service packages include a full physical exam, completion of Form I-693, the Quantiferon TB Gold test, an RPR/syphilis test, and urine tests. Vaccinations are priced separately. The clinic works directly with patients and welcomes referrals from immigration attorneys. Their flexible, family-friendly scheduling is designed to meet a variety of timelines.
Conclusion and Key Takeaways
When applying for adjustment of status in the United States, a USCIS-designated civil surgeon plays a key role in completing the required immigration medical exam. Their job is to assess your health based on federal admissibility standards, fill out Form I‑693 accurately, and provide it in a sealed envelope. However, they do not decide whether you’ll receive a green card – that decision is made by a DHS officer.
Before scheduling your appointment, make sure to confirm the surgeon’s USCIS designation using the official "Find a Civil Surgeon" tool. Bring your vaccination records and a government-issued photo ID to the exam. And remember, the sealed Form I‑693 envelope must remain unopened.
"The civil surgeon’s primary role is to perform immigration medical examinations to assess whether aliens have… medical conditions that could result in their inadmissibility." – USCIS
Starting December 2, 2024, Form I‑693 must accompany your Form I‑485 using the 01/20/25 edition. Exams signed on or after July 3, 2025, will only be accepted with this version of the form.
FAQs
How do I find a USCIS-designated civil surgeon near me?
You can use the Find a Civil Surgeon tool on the official USCIS website to locate a USCIS-designated civil surgeon. Simply enter your city, state, or ZIP code to find authorized physicians near you. If you need assistance, you can also call the USCIS Contact Center at 800-375-5283. Refugees have another option – they can visit their local health department, which is authorized to handle the necessary vaccination assessments.
What happens if my I-693 envelope is opened or tampered with?
USCIS mandates that Form I-693 be submitted in a sealed envelope provided by your civil surgeon. If this envelope is opened or tampered with, USCIS might reject it and send a Request for Evidence (RFE). In such cases, you’ll either need to obtain a new sealed form or resolve the issue with the civil surgeon. However, if you’re filing Form I-485 online, you are required to open the envelope to upload the document.
Can I submit my I-693 after I file Form I-485?
No, Form I-693 does not have to be submitted at the same time as Form I-485. While it’s often convenient to file them together, USCIS allows you to submit Form I-693 later if needed. However, delaying the submission could slow down the processing of your application. For those in Los Angeles, USCIS Immigration Medical Exam Specialists provide USCIS-approved medical exams, including physicals, necessary tests, and completion of Form I-693. They also offer both standard and expedited services to meet your timeline.
