Form I-693 Explained: The Filing Rules That Matter in 2026

What Form I-693 Is

Form I-693 is the Report of Immigration Medical Examination and Vaccination Record. It is the paper record of your immigration medical exam. If you are applying for a green card from inside the United States, you file Form I-485, Application to Register Permanent Residence or Adjust Status. USCIS asks for the medical exam as part of that application.

The form is not something you fill out at home. A doctor completes it. That doctor must be a civil surgeon designated by USCIS. Not every doctor can do this. Only doctors on the USCIS list can sign Form I-693.

If you are outside the U.S. and going through consular processing, this form does not apply to you. You will see a panel physician chosen by the U.S. Department of State instead.

Who Fills Out Each Part

Form I-693 has parts for you and parts for the doctor. Knowing the split helps you avoid mistakes.

• You: your name, address, date of birth, and other basic information about you.
• You: your medical and vaccine history, as best you know it. Bring records so this part is accurate.
• The civil surgeon: the physical exam findings.
• The civil surgeon: lab results, like the tuberculosis blood test and the other screening tests.
• The civil surgeon: the vaccine section, including which shots you have had and which ones you still need.
• The civil surgeon: the signature and date at the end. That signature is what USCIS looks at.

The Rule That Matters Most: File I-693 With I-485

This is the rule that catches people. Since December 2, 2024, USCIS generally requires Form I-693 to be submitted together with Form I-485. If you send an I-485 without the medical form, USCIS can reject the filing.

That means the exam is not a later step you can put off. It is part of the packet. Plan your exam early enough that the civil surgeon can finish the form and hand it back to you before you mail your I-485.

Some lab results take time. Blood test results usually take a few days to two weeks before the civil surgeon can complete the form. Build that wait into your plan.

Rules can change. Before you file, check the current Form I-693 instructions and the I-485 filing rules on uscis.gov.

The 60-Day Signature Window

There is a clock on the civil surgeon's signature. The civil surgeon must sign Form I-693 no more than 60 days before you file Form I-485.

So an exam done too early can go stale. If your signed form is older than 60 days when you file, it may not be accepted. You may need a new exam or a new signature.

The practical tip: work backward from your filing date. Book the exam, get the labs done, and pick up the sealed form inside that window. Do not sit on a signed form for months.

If your filing date slips, ask the civil surgeon's office about the date on your form before you send anything.

The Sealed Envelope Rule

When the exam is done, the civil surgeon gives you the completed Form I-693 in a sealed envelope. That envelope is for USCIS, not for you.

Do not open it. Do not peek, do not copy it, do not take out the staples. A sealed envelope that has been opened may not be accepted, and you could need a new form.

Send the sealed envelope with your Form I-485 packet. Keep it flat and dry. If you are working with an immigration lawyer, hand the sealed envelope to them unopened.

Ask the civil surgeon's office how they hand over the form, since offices handle this differently.

What the Exam Covers and What to Bring

The exam is usually quick and simple. The civil surgeon reviews your medical and vaccine history, does a physical exam, and orders lab tests. The tests often include a tuberculosis blood test (IGRA) for applicants age 2 and older, a syphilis blood test for ages 18 to 44, and a gonorrhea urine test for ages 18 to 24. A chest X-ray is done only if needed. There is also a mental health and substance use screening.

Vaccines depend on your age and your records. They can include MMR, Tdap or Td, polio, hepatitis A and B, varicella, influenza in flu season, and others. COVID-19 vaccination is no longer required for Form I-693 since January 22, 2025.

Here is what to bring to the visit:

• A government photo ID, like your passport.
• Your vaccination records.
• A list of medicines you take now.
• Past chest X-ray results, if you have them.
• Payment for the visit.
• Bring records even if they are old. Old vaccine records can save you shots and money.

Cost, Timing, and Checking the Rules

USCIS does not set the price of the exam. Each civil surgeon sets their own fee. Total cost commonly runs from about $200 to $500 or more. The final number depends on your city, the lab tests you need, and how many vaccines you need. Health insurance often does not cover it, so ask about the fee before you book.

You can check that a doctor is a civil surgeon with the USCIS Find a Civil Surgeon tool on uscis.gov. That tool is the official list.

If you want to compare options near you, you can browse civil surgeons by city on our site. Read a few listings, call about the fee and the wait time, and pick the office that fits your filing date.

An immigration lawyer is not required for a green card. Some people hire one for complex cases, like past visa problems, criminal records, prior denials, or removal proceedings. For the medical form itself, the civil surgeon is the person who signs.

One last thing: rules and forms can change. Confirm the current Form I-693 requirements on uscis.gov before you file.