Green Card Medical Exam FAQ's

Generally, all the applicants filing for adjustment of status to that of a lawful permanent resident must submit Form I-693 completed by a designated Civil surgeon. Form I-693 is used to report results of a medical examination to the U.S. Citizenship and Immigration Services (USCIS).

The purpose of the Immigration Medical Exam is to ensure that the applicant is not inadmissible to United States on public health grounds. The Immigration Medical Exam process includes Vaccination, Tuberculin (TB) tests and Physical examinations. The physical examinations may consist of blood tests, urine tests, x-rays for Tuberculin tests as per prior medical records and the applicants' mental state and drug abuse levels are examined. A list of these health grounds can be found in section 212(a) (1) of the Immigration and Nationality Act

Generally, all applicants filing for immigrant visas and some non-immigrant visas, refugees and adjustments of status to that of a permanent resident, must submit Form I-693 completed by a designated Civil surgeon. Form I-693 is used to report results of a medical examination to USCIS.
The examination is required to establish that you are not inadmissible to the United Status on public health grounds.


A Medical exam is generally confined to a standard physical exam including blood and urine tests and x-rays, prior medical records as well as the applicants' mental state is examined.
A Civil surgeon is a licensed and experienced doctor (Physician) approved/authorized by the USCIS to conducted immigration medical exam.
No, Only the licensed and experienced doctors approved by the USCIS, who are familiar with immigration medical policy and updates can perform this exam. Usually called as,
  • Civil Surgeon (In the U.S)
  • Panel Doctor (Outside of the U.S)
Applicants may find the designated Civil surgeon on www.easyime.com where applicants can schedule online appointment with the Civil surgeon in their nearest area. Website also offers helpful tools such as Civil Surgeon's price comparison, office hours and other related services.

Alternatively, applicants can go to USCIS website to find Civil surgeon.
Physical examination: Required for all applicants, regardless of age which consists of physical examination and evaluation of :

  • Blood pressure, eye test, check your knees, elbows, and may also include an exam of your genital organs.
  • A review of your mental status.
  • Evaluation of physical and mental disorders with associated harmful behaviors and substance-related disorders
  • Other Sexually Transmitted Diseases (Chancroid, Gonorrhea, Granuloma Iguinale, Lymphogranuloma Venereum)
  • Other Physical or Mental Abnormality, Disease or Disability

Tuberculin (TB) Test:
Applicants who are over the age of 2 years require a Tuberculin Skin Test. Sometimes even the applicants under the age of 2 may require the test if tuberculosis is suspected or if the applicant has a history of TB.

Serologic (blood) Test for Syphilis:
All applicants 15 years of age and above are required to have a Serologic Test for Syphilis. A Serologic Test may be required for an applicant even under the age of 15 if a possibility of infection is suspected.

Vaccinations:
According to United States Immigration Laws, for adjustment of status, the following vaccinations are required:

  • Mumps
  • Measles
  • Rubella
  • Polio
  • Tetanus and Diphtheria toxoids
  • Pertussis
Those applicants who believe that compliance with the vaccination requirements would be against their religious beliefs or moral convictions still are eligible for Adjustment of Status. You will need to apply for a waiver of vaccination requirements.
In that case, only a panel physician approved by the visa issuing U.S. Embassy/Consulate can conduct the exam.
Your closest Consulate or Embassy of the United States Consular office may assist you in getting the names of recognized Panel Physicians.
Some doctors include the cost of standard vaccinations in the cost of the medical exam, most will charge for any vaccinations required in addition to the cost of the medical exam and any laboratory fees.

The applicant is responsible for paying all costs of the medical exam, including the cost of any follow-up tests or treatment that may be required. Payments are made directly to the Civil surgeon and/or related health care facility.
This depends on where the applicant is applying for a Medical Exam. There are two different forms needed by the applicant filing for adjustment of status to that of a lawful permanent resident depending on where he/she applying from.

  • Applicants applying in the United States have to submit Form I-693 Completed by a designated Civil surgeon. Or,
  • Applicants applying outside the United States have to submit Form DS-2053 (Formerly Form OF-157) given by the U.S. Consular.
Your Civil surgeon (Physician) will provide you the respective form.
The visa applicant may be required to provide the following documents at medical exam:
  • Government Issued Photo Id.
    For Example Passport / Driving license.
  • passport size photograph (applying outside of the United State).
  • Appointment letter for visa interview.
  • Medical history Documents, if any
In that case, if the chest x-ray is not recommended by the doctor,then the applicant has to wait until it is safe again to take a chest x-ray. The doctor would give only the allowed vaccines and ask the applicant to take other vaccines after the baby is delivered.
Doctor would also ask to have the gynecologist tests (if any) results.
  • Communicable disease of public health significance.
    It includes 9 infectious medical conditions defined in the HHS regulations.

    1. Severe acute respiratory syndrome (SARS)
    2. Tuberculosis (TB)
    3. Leprosy
    4. Human immunodeficiency virus (HIV/AIDS)
      An Applicant who tests positive for HIV may be able to file a Waiver application.The applicant must also show that his /her Admission in to U.S.:
      1. Posed minimal public health danger
      2. Holds minimal possibility of spread of infection
      3. Will not incur costs to any government agency without Prior consent from that agency.
    5. Syphilis (infectious State).
    6. Cancroids (STD similar to syphilis and herpes)
    7. Gonorrhea.
    8. Granuloma inguinale (STD donovanosis)
    9. Lymphogranuloma (STD chlamydia)

  • Lack of required vaccinations (for immigrant visa applicants only);
  • Physical or mental disorders with harmful behavior.
  • Drug abuse or drug addiction.
It must be determined by the Civil surgeon or panel physician which applicants are considered inadmissible on medical grounds subject to the applicant’s physical or mental condition.

If applicant’s physical or mental behavior has no associated harmful behavior then applicant is still eligible for the application process.
A medical waiver permits an immigration applicant to be allowed into, or remain in the United States despite having a health condition identified as medical grounds of inadmissibility. Terms and conditions may be applied to a medical waiver on a case-by-case basis.

Applicants can apply for a waiver if:

Applicant is Spouse or unmarried son or daughter or the minor, unmarried adopted child of a U.S. Citizen or Legal Permanent Resident (LPR); or
Applicant has a son or daughter or lawfully adopted child who is a U.S. citizen or LPR; or
Applicants are eligible for classification as a self-petitioning spouse or child (including your derivative children) because of abuse.
After the medical exam is complete, the Civil surgeon will certify the results on the appropriate forms and place them in a sealed envelope with label on the back - “DO NOT OPEN THE SEALED ENVELOPE.”

Do not accept it if it is not in a sealed envelope. USCIS will return the form to you if it is not in an envelope or if the envelope has been opened or altered.

You, the applicant, not the Civil surgeon, are required to submit the Form I-693 to USCIS.

You need to turn in your envelope with your immigration application.

Follow the instructions on or included with the application or the instructions given to you by the office requesting the medical examination.
The results of the medical examination are generally valid for only 12 months. Applicants should schedule the medical examination as close as possible to the time they file for adjustment of status, but provide for sufficient time for the performance of laboratory testing or additional testing required under CDC's Technical Instructions.
The results of your medical examination are confidential and are used for immigration purpose only. When required to do so by law, the Civil Surgeon may share your results with public health authorities.
When an applicant has a health condition which is a public health concerns to the United States, he/she may not get immigration benefit on Medical Grounds of Inadmissibility.

The medical grounds of inadmissibility under U.S. immigration laws are divided into four categories:

(a) Communicable diseases of public health significance;
(b) Lack of required vaccinations;
(c) Physical or mental disorders with harmful behavior; and

(d) Drug abuse or addiction.

The Civil surgeon is required to perform a general physical examination and specific evaluations, as described below.

Communicable Diseases of Public Health Significance.

The Civil surgeon is required to perform specific tests for TB, syphilis. The medical exam also indicates an evaluation for other sexually transmitted diseases and Hansen's Disease (leprosy).

Tuberculosis (TB)
All applicants two years of age and older are required to be tested for tuberculosis (TB) with an initial screening test. Civil Surgeons may require an applicant younger than two years of age to undergo testing if there is evidence of contact with a person known to have TB or other reasons to suspect TB.
The physician may use either the Tuberculin Skin Test (TST) or an Interferon Gamma Release Assay (IGRA).

  1. Tuberculin Skin Test (TST) given by the Mantoux technique. After the skin test, you will need to return to the Civil surgeon within 48 to 72 hours to have the result read. If you have a reaction of four millimeters or less, generally, you will not need any further tests for TB. A chest x-ray is required when the reaction to the TST is five millimeters or more. The Civil surgeon will explain the medical requirements to you in more detail.
  2. IGRA: IGRAs are blood tests that are options to the TST (see update to the Technical Instructions at http://www.cdc.gov/immigrantrefugeehealth/exams/ti/civil/technical-instructions-civil-surgeons.html) You will not have to return to the Civil surgeon's office for the result to be read. The result is generally available within 24 hours. If the test is negative or indeterminate/borderline/equivocal, you generally will not need any further tests for TB. Depending on the result of the test, further evaluation with a chest x ray may be required.
       Tests not listed in the materials published on this link may not be used for purposes of this immigration medical examination.
       The Civil surgeon will explain the medical requirements and the suitability and availability of IGRA testing to you in more detail.
Syphilis
All applicants 15 years of age and older must have a blood test for syphilis. Civil Surgeons may require applicants under 15 years of age to be tested if there is reason to suspect the possibility of infection.

If you are found to have a communicable disease of public health significance, the Civil surgeon will advise you how to obtain any necessary treatment. It also may be necessary for you to apply for a waiver of inadmissibility. USCIS will advise you if this is necessary. To obtain more information about this waiver, visit the USCIS Web site at www.uscis.gov.


Vaccination Requirements


All applicants for adjustment of status must present documents showing they have been vaccinated against a broad range of vaccine-preventable diseases. The Civil Surgeon will review your vaccination history with you to determine whether you have all the required vaccinations. Make sure you take your vaccination records with you to your appointment with the Civil surgeon.

NOTE:
Do not attempt to meet the requirements before you are evaluated by the Civil surgeon, in case it is not medically appropriate for you to have one or more of the required vaccines.

By law, the required vaccines for the immigration population are the vaccines as recommended by the ACIP for the immigrant population. You may obtain a list of the required vaccines from CDC's Web site at http://www.cdc.gov/immigrantrefugeehealth/exams/ti/civil/vaccination-civil-technical-instructions.html

If you never received or are unable to prove you received certain vaccines, the Civil surgeon can administer them to you. After evaluation by the Civil surgeon, you also have the option of asking your family doctor to administer those vaccines to you and showing the records to the Civil surgeon to note on Form I-693.

If you initially did not have documents proving you received all the required vaccines but later submit those documents, or if the Civil surgeon certifies that it is not medically appropriate for you to have one or more of the missing vaccine(s), USCIS may grant you a waiver based on the Civil surgeon's certification on the vaccination supplement.

HHS has determined that a vaccine is "not medically appropriate" if :

(a) The vaccine is not recommended for your specific age group;
(b) There is a medical reason why it would not be safe to have the vaccine (for example, allergies to eggs and yeast, hypersensitive to prior vaccines, other medical reasons);
(c) You are unable to complete the entire series of a required vaccine within a reasonable amount of time; or
(d) For the influenza vaccine, it is not the flu season.

If you object to receiving the recommended vaccinations because of your sincerely held religious beliefs or moral convictions, you may apply for a waiver of these requirements. If you hold these objections, inform the Civil surgeon that you will apply for a waiver. If the waiver application is denied, you may be ineligible for the immigration benefit that you are seeking. To obtain more information about these waivers, visit the USCIS Web site at www.uscis.gov.


Physical or Mental Disorders


Are all physical or mental disorders considered health-related grounds of inadmissibility?

No. The emphasis is more on the behavior associated with the physical or mental disorder, instead of the physical or mental disorder itself. This means that the Civil surgeon must determine that there is behavior associated with the disorder that is harmful either to you, to others, or to property. If you have had a history of a physical or a mental disorder, there must be associated harmful behavior that is likely to recur in order for you to be considered inadmissible.

The Civil surgeon will ask you general questions during the medical exam to determine whether you have such a condition. Depending on the outcome of the initial exam, the Civil surgeon may find it necessary to refer you to a specialist for further testing.

If the Civil surgeon finds that you have a physical or mental disorder with associated harmful behavior, you may apply for a waiver according to the terms, conditions, and controls determined necessary by USCIS in consultation with HHS. To obtain more information about these waivers, visit the USCIS Web site at www.uscis.gov.


Drug Addiction/Drug Abuse


What are the guidelines for determining whether someone is a drug abuser/drug addict?

The Civil surgeon will review your medical history during the medical exam and ask you questions necessary to determine whether you are currently using or have used in the past any drugs or other psychoactive substances. The medical guidelines for determining drug abuse and drug addiction are determined by HHS.

If the Civil surgeon determines you have a medical condition of drug addiction/abuse, you are noteligible to apply for a waiver unlessyou are applying for adjustment of status one year after you were admitted as a refugee, or you are applying for adjustment of status one year after you were granted asylum. If you are ineligible to apply for a waiver, but are later found by the Civil surgeon to be in remission from the drug abuse or drug addiction (as determined by HHS), you may proceed with your adjustment-of-status application, if eligible.
It takes approximately one to three visits to complete the Medical Exam.
Yes. Send an email request to imesupport@esmsys.com from the account you used to register with us, with your Name and Phone Number, and we will re-send your Username and Password.
There are still many steps involved in obtaining a Green Card besides your Immigration Medical Exam. You can find more information by visiting the USCIS website at www.uscis.gov.