What medical tests are done for a green card? 

TL;DR 

• The green card medical exam (Form I-693) must be completed by a USCIS-designated civil surgeon in the U.S., and your results are provided to you in a sealed envelope for USCIS. (USCIS) 

• Required screening includes tuberculosis (TB), syphilis, gonorrhea (age-based), a vaccination review/updates, and a general physical and mental health assessment per CDC Technical Instructions. (CDC) 

• USCIS does not set the exam price—fees vary by clinic based on labs and vaccines needed. (You’ll book with a civil surgeon; compare prices to find the cheapest immigration medical exam that fits your timeline.) (USCIS) 

Table of contents 

1. Quick overview: what the I-693 exam checks 

2. Required tests (and who must take them) 

3. Vaccination review and updates 

4. The physical exam & mental health review 

5. Do I need drug testing or an X-ray? 

6. How the appointment works (step-by-step) 

7. How much it costs (and why prices vary) 

8. Common mistakes to avoid 

9. FAQs 

10. Sources (USCIS/CDC) 

1) Quick overview: what the I-693 exam checks

The Form I-693, Report of Medical Examination and Vaccination Record documents that you aren’t inadmissible on health grounds and that you meet vaccination requirements. Inside the U.S., only a USCIS-authorized civil surgeon can perform the immigration medical exam for a green card; outside the U.S., a panel physician (Department of State) performs a similar exam. After your visit, the civil surgeon completes the I-693 and provides it sealed for USCIS. (USCIS) 

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2) Required tests (and who must take them)

A) Tuberculosis (TB) screening 

Civil surgeons follow CDC TB Technical Instructions. The exam generally uses a TB blood test (IGRA) for applicants age 2+, with follow-up (such as chest X-ray and evaluation) if results or symptoms indicate. Management and any required reporting are per CDC/local health rules. (CDC) 

B) Syphilis testing 

CDC Technical Instructions require syphilis testing for applicants aged 18 to <45; applicants <18 or ≥45 are tested if there’s reason to suspect infection. Results are interpreted using CDC-accepted algorithms and recorded on I-693. (CDC) 

C) Gonorrhea testing 

CDC Technical Instructions require gonorrhea testing for ages 18–24; those outside this range are tested if clinically indicated. Testing is typically a NAAT ordered by the civil surgeon at the time of the exam. (CDC) 

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3) Vaccination review and updates 

The civil surgeon must verify you meet vaccine requirements set by CDC for immigration purposes (for example, age-appropriate MMR, varicella, Tdap, polio, hepatitis B, influenza when in season, and others depending on age and history). If a vaccine is not medically appropriate (e.g., too young/old, contraindication, or not flu season), the civil surgeon documents that on the form. You may receive needed vaccines during your visit or via referral. (CDC) 

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4) The physical exam & mental health review 

Beyond labs and vaccines, the civil surgeon performs a medical history and physical examination, and assesses for conditions that may trigger inadmissibility (communicable diseases of public health significance, harmful behavior related to a mental disorder, and substance-related conditions). Findings are recorded on the I-693 and classified per USCIS/CDC guidance. (USCIS) 

5) Do I need drug testing or an X-ray? 

• Drug test: CDC/USCIS don’t require a routine drug screen for all applicants. Instead, civil surgeons evaluate for substance-related disorders based on history, exam, and indicated testing. (A clinic may order tests if clinically warranted.) (USCIS) 

• Chest X-ray: Not everyone needs one. It’s performed when indicated (for example, based on TB screening results/symptoms) under CDC TB instructions. (CDC) 

6) How the appointment works (step-by-step) 

1. Find and book a USCIS-designated civil surgeon. Use the official USCIS Find a Civil Surgeon tool, then compare prices & availability to choose the right clinic. Bring government-issued photo ID and any vaccination records. (USCIS) 

2. History, physical, and lab orders. The doctor reviews your medical history, performs the exam, and orders TB, syphilis, and gonorrhea tests as required (plus vaccines). (CDC) 

3. Vaccinations given or updated. Any missing required vaccines can often be administered during the visit (or via referral). (CDC) 

4. Form completion & sealed packet. When results are back, the civil surgeon completes Form I-693, gives you a copy for your records, and provides the official sealed envelope for USCIS. Do not open the sealed packet. (USCIS) 

CTA: Compare civil surgeons by price & availability → Book now (internal links).

7) How much it costs (and why prices vary) 

There is no USCIS fee for the medical exam; clinic prices vary based on the office fee, required labs, and any vaccines you need. Because costs aren’t standardized, it’s smart to compare immigration exam clinics to find the cheapest immigration medical exam that still meets your timing and service needs. (USCIS) 

8) Common mistakes to avoid 

• Using a non-designated doctor (inside the U.S. you must use a USCIS civil surgeon). (USCIS) 

• Opening the sealed envelope—USCIS requires the original sealed I-693. Keep your personal copy separate. (USCIS) 

• Skipping vaccine records—bring what you have to avoid repeat visits. (CDC) 

• Assuming old validity rules. USCIS updated I-693 validity policy on June 11, 2025; follow the current instructions tied to your I-485 filing. (USCIS) 

FAQs 

What exactly does the green card medical exam include? 
TB blood test (with follow-up as needed), syphilis and gonorrhea testing (age-based), vaccination review/updates, and a physical/mental health assessment. All findings are documented on Form I-693 by a USCIS-approved physician (civil surgeon). (CDC) 

Do children need TB testing? 
CDC Technical Instructions require TB screening for applicants age 2+ (younger children are evaluated if clinically indicated). Your civil surgeon will follow CDC protocols. (CDC) 

Who must be tested for syphilis and gonorrhea? 

• Syphilis: test ages 18 to <45; others if indicated. (CDC) 

• Gonorrhea: test ages 18–24; others if indicated. (CDC) 

Will I get all required vaccines at the appointment? 
Often yes, but it depends on clinic stock and your records. The civil surgeon must ensure you meet CDC vaccine requirements and record valid medical reasons if a vaccine isn’t given. (CDC) 

Is there a drug test? 
There’s no blanket drug screen requirement. Civil surgeons assess substance-related disorders and order tests when medically indicated. (USCIS) 

Do I need to submit the results myself? 
Yes. You’ll submit the sealed I-693 envelope with your I-485 (or in response to an RFE). Do not open the envelope; USCIS will reject opened packets. (USCIS) 

Clear next steps 

• Find an immigration doctor: Use USCIS’s Civil Surgeon Locator to identify USCIS-approved doctors near you. (USCIS) 

• Compare options: Use EasyIME to compare civil surgeons by price & availability and pick your Green Card exam doctor. 

• Book now: Bring photo ID and vaccination records; keep your sealed envelope closed for USCIS. 

CTA: Compare civil surgeons by price & availability → Book now 

Sources (USCIS/CDC) 

• USCIS — Form I-693 page (sealed-envelope acceptance, current edition). (USCIS) 

• USCIS — Find a Civil Surgeon (locator; keep a personal copy before sealing). (USCIS) 

• CDC — TB Technical Instructions for Civil Surgeons (IGRA-based screening and follow-up). (CDC) 

• CDC — Syphilis Technical Instructions (testing ages and interpretation). (CDC) 

• CDC — Gonorrhea Technical Instructions (testing ages and NAAT at time of exam). (CDC) 

• CDC — Vaccination Technical Instructions (age-based vaccine table). (CDC) 

• USCIS — Policy update on I-693 validity (June 11, 2025) and Policy Manual notes. (USCIS)