What to Expect From the Green Card Medical Exam: Tests, Forms & Process

The green card medical exam is a health screening documented on Form I-693 and completed by a USCIS-designated civil surgeon inside the United States or a panel physician abroad. Its purpose is to confirm that you are not inadmissible on health-related grounds under the Immigration and Nationality Act.

The exam includes a medical-history review, a physical examination, a mental-health evaluation, testing for tuberculosis, syphilis, and gonorrhea, and a review of your vaccination records. Your civil surgeon seals the completed results for USCIS submission, and costs typically run $200 to $500 plus any needed labs and vaccines.

Pollak PLLC helps green card applicants in Dallas and Fort Lauderdale prepare for every step of this process.

What Is the Green Card Medical Exam?

USCIS requires this exam for most green card applicants adjusting status inside the United States. The exam is officially documented on Form I-693, the Report of Medical Examination and Vaccination Record, and is required for most applicants filing Form I-485 for adjustment of status.

This is not a routine physical. The civil surgeon evaluates specific health criteria defined by the CDC and USCIS, records the findings on Form I-693, and seals the completed form for submission with your I-485 application. Errors or omissions on the form can trigger a Request for Evidence from USCIS, which adds weeks to your timeline.

Who Can Perform the Green Card Medical Exam?

Only a USCIS-designated civil surgeon can perform the immigration medical exam inside the United States. A regular family doctor or personal physician cannot complete Form I-693, regardless of their qualifications. You can locate a designated civil surgeon in your area using the USCIS "Find a Civil Surgeon" tool on the agency's website.

If you are applying for your green card through consular processing abroad, the exam is performed instead by a U.S. Department of State-designated panel physician at an approved clinic near the U.S. Embassy or Consulate where your interview is scheduled.

Why Trust Pollak PLLC to Guide You Through the Green Card Medical Exam

Pollak PLLC brings more than 27 years of exclusive immigration law experience to every adjustment of status case the firm handles. Managing Attorney Karen-Lee Pollak advises clients on when to schedule the medical exam, how to avoid I-693 validity and rejection issues, and how a medical history involving past drug use, prior TB, or a mental health condition could affect admissibility.

The firm has earned recognition from Chambers (2019), Super Lawyers (2014 through 2024), D Magazine Best (2024), and Avvo, for consistent results in family-based, employment-based, and investment-based immigration. With offices in Addison, Texas (Dallas metro) and Fort Lauderdale, Florida, Pollak PLLC serves clients nationwide who need personalized guidance through every stage of the green card process.

Do I Need a Lawyer for the Green Card Medical Exam?

The exam itself is performed by a civil surgeon, not an attorney. However, if you have any concerning medical history, an immigration attorney should advise you before your appointment. The findings your civil surgeon records on Form I-693 go straight to USCIS and factor into whether you are found admissible, and certain results can trigger delays or grounds of inadmissibility.

If you have a history of substance use, a prior positive TB test, a treated STI, or a mental health condition, talk to an immigration attorney before the appointment. This gives you time to gather treatment records, remission documentation, and any other supporting evidence before the civil surgeon completes the form.

Preparing beforehand is far more effective than responding to a problem after the I-693 has been sealed.

What Do They Test for in the Green Card Medical Exam?

The immigration medical exam has five standard components, each required by CDC Technical Instructions and documented on Form I-693 by your civil surgeon.

Your civil surgeon begins with a medical-history review, asking about past illnesses, hospitalizations, current medications, and any history of mental health treatment or substance use. The physical examination covers your eyes, ears, nose, throat, heart, lungs, abdomen, lymph nodes, skin, and extremities, along with height, weight, and vital signs.

The surgeon also conducts a mental-health and cognitive evaluation, assessing mood, behavior, comprehension, and judgment. This only raises admissibility concerns when a condition is linked to harmful behavior.

Lab testing includes communicable-disease screening. Tuberculosis screening uses an IGRA blood test (such as QuantiFERON-TB Gold) for all applicants age 2 and older, with a chest X-ray ordered only if the IGRA result is positive or symptoms are present. Syphilis requires a blood test, and gonorrhea requires a urine test, both following age-based CDC guidelines.

Finally, the surgeon reviews your vaccination records, which is covered in the next section.

What Blood and Urine Tests Are Done for a Green Card?

The CDC requires a syphilis blood test for applicants ages 18 to under 45, and for anyone else if clinically indicated. Gonorrhea screening requires a urine test for applicants ages 18 to 24, with testing for older applicants ordered when the surgeon determines it is warranted.

TB screening relies on an IGRA blood test, with a chest X-ray required as a follow-up if the result is positive. There is no routine HIV test; that requirement was removed from the immigration medical exam years ago, though it remains a common question among applicants.

Does the Green Card Medical Exam Include a Drug Test?

There is no automatic drug panel in the green card medical exam. The civil surgeon asks structured questions about your past and current use of controlled substances and alcohol. A laboratory drug test is ordered only if your responses, medical records, or observed behavior raise a clinical concern about active use.

A single past instance of experimentation does not typically lead to an inadmissibility finding. The examining physician evaluates whether substance use rises to the level of a substance use disorder under DSM-5 criteria, which requires meeting at least two of eleven clinical indicators.

If a current disorder involving a controlled substance is found, it is classified as a Class A condition, which we cover in detail below.

Tests by Age Group

Vaccinations Required for the Green Card Medical Exam

Green card medical exam vaccinations are one of the most common sources of delay. The civil surgeon checks your immunization records against the CDC/ACIP immigration vaccination schedule and administers any missing doses during your visit. The vaccination requirement comes from the Immigration and Nationality Act, and the CDC maps the ACIP recommendations onto a narrower immigration-specific list organized by age group.

Only the first dose of a multi-dose series is required before the surgeon can sign your Form I-693. If you are missing records, your doctor can either administer the vaccine at the appointment or order titers (blood tests that confirm immunity) as an alternative.

Religious or moral objection waivers are available for applicants who cannot receive certain vaccines, though missing age-appropriate vaccines without a valid waiver will be coded as a Class A condition on your I-693.

COVID-19 vaccination is no longer required as of January 22, 2025. USCIS will not issue Requests for Evidence or denials based on missing COVID-19 documentation.

What Vaccines Are Required for a Green Card?

The required vaccines vary by age, but the full CDC immigration list includes the following categories:

Not every vaccine on this list applies to every applicant. Your doctor uses the CDC vaccination chart organized by age and risk factors to determine which vaccines must appear on your I-693 as "given," "immune," or "not medically appropriate." Adults who received their complete childhood immunization series and have documentation typically need only a Tdap booster and a seasonal flu vaccine at the appointment.

How to Prepare: What to Bring and the Sealed I-693 Envelope

Good preparation prevents delays and repeat visits. Bring the following to your appointment:

• Government-issued photo ID (passport, state ID, or driver's license)
• Form I-693 with Part 1 completed but not signed (your civil surgeon completes the rest)
• Vaccination and immunization records, translated into English if needed
• A list of all current medications
• Records of any prior treatment for TB, STIs, or chronic conditions
• Payment (confirm the amount and what it includes when you schedule)

After completing the exam and reviewing your lab results, the surgeon places the finished Form I-693 in a sealed envelope. Do not open that sealed envelope. USCIS will reject any I-693 received in an unsealed or tampered envelope, which means you would need to repeat the exam entirely. Keep your personal copy of the completed form for your own records.

How Much Does the Green Card Medical Exam Cost?

USCIS does not set the fee for the immigration medical exam. Civil surgeons set their own pricing, and the total cost typically ranges from $200 to $500 for the base exam. Labs, vaccines, and a chest X-ray (if needed) are usually billed separately and can add to the final amount.

County health departments and community clinics tend to charge less than private practices. When you call to schedule, ask specifically what the quoted price includes so there are no surprises on your final bill. Some clinics bundle labs and form completion into one fee, while others charge for each component separately.

How Long Is Form I-693 Valid, and When Should I Schedule It?

For forms signed by a civil surgeon on or after November 1, 2023, the I-693 is valid while the associated I-485 application remains pending. If you have seen older guides citing a two-year expiration, that rule has changed.

As of December 2, 2024, USCIS requires Form I-693 to be submitted at the same time as your Form I-485. If it is missing, USCIS can reject the entire application package before any officer reviews your case.

In June 2025, USCIS further clarified that a completed I-693 is valid only for the specific application it was submitted with, meaning a denied or withdrawn I-485 requires a brand-new exam for any future filing.

Schedule your exam close to your I-485 filing date, and confirm that your civil surgeon is using the current form edition (01/20/25). Filing too early or using an outdated edition can result in a Request for Evidence that adds weeks to your timeline.

Health Conditions That Can Affect Your Green Card (and How to Handle Them)

The immigration medical exam screens for conditions listed under the health grounds of inadmissibility in INA 212(a)(1). Most of these are manageable with the right preparation, and an immigration attorney can help you prepare before the appointment.

Four health-related grounds of inadmissibility exist under the statute:

• A communicable disease of public health significance (such as active, untreated tuberculosis or untreated syphilis or gonorrhea)
• Failure to show proof of required vaccinations
• A physical or mental disorder with associated harmful behavior, or harmful behavior that is likely to recur
• Drug abuse or addiction involving a controlled substance

If the civil surgeon identifies one of these conditions, it is classified as either Class A or Class B on your Form I-693.

If you have a medical history that could raise concerns, the best approach is to prepare before your appointment. Bring treatment records, proof of completed medication courses, documentation of remission, and any letters from treating physicians.

If you have a DUI on your record, be aware that it can implicate the mental-disorder and harmful-behavior category even if you do not consider yourself to have a substance issue.

A former Class A condition that has been treated and is now reclassified as Class B is no longer a ground of inadmissibility. The surgeon makes this determination based on the evidence you provide, so come to the appointment with your documentation ready.

Can You Fail the Green Card Medical Exam?

There is no pass/fail grade on the green card medical exam. The surgeon records findings on your I-693 and classifies any conditions as Class A or Class B, but the exam itself does not produce a single outcome that approves or rejects you.

If a Class A condition is identified, whether a communicable disease of public health significance, a substance use disorder, or a mental disorder with harmful behavior, it must be addressed before USCIS will approve your application under INA 212(a)(1).

In many cases, treatment, documentation of cure, or a waiver resolves the issue. The exception is drug abuse or addiction involving a substance listed in the Controlled Substances Act, where the path forward is documenting at least 12 months of sustained remission on a new Form I-693.

Be honest with your civil surgeon, and discuss any health concerns with an immigration attorney before the appointment. Millions of applicants complete this exam every year, and preparation and transparency count for far more than a perfect medical history.