Your Immigration Medical Exam (i-693): a step by step guide for success

Whether your green card application is based on family, employment, visa lottery, political asylum or any other means, everyone must file a completed Green Card, or Immigration Medical Exam ( also known as an I-693, I693, or I 693 form) before approval. If you want to get a green card “fast” (and of course that term is relative) you need a properly completed green card medical exam.

The purpose of the Immigration Medical Exam is to ensure that applicants who are applying for permanent residence are not inadmissible to the US on grounds of public health, and do not pose a health risk to the citizens of the US. In this post we look at what to expect from your exam, what you will need to bring with you, as well as proper steps to better ensure success.

[Note: This post is about green card applications in the United States, also called Adjustment of Status. Filing green cards overseas requires a different green card medical exam form.]

Will my health condition stop me from getting my Green Card?

Don’t be afraid that common health problems like a flu, or old-age-related illnesses are going to block you from getting your Green Card. The exam is only to look at health issues that are related to immigration. If you have illnesses that affect you, but do not affect others, like heart disease, cancer and even certain mental illnesses, you can still be admissible to the US.

Only certain medical conditions can make you inadmissible to the United States. More importantly some of these conditions can be “legally forgiven” or waived.

If you have any concerns or questions, you should get the help of an immigration lawyer who can give you a full analysis, and help you fill in the waiver.

What illnesses or diseases would make me fail my immigration medical exam?

As of 2018, if you’re applying to get your green card in the United States, the diseases that can make you inadmissible are:

  • gonorrhea
  • infectious leprosy (Hansen’s disease)
  • infectious stage syphilis
  • active tuberculosis

If you are outside the country and trying to get your visa at a US consulate, other kinds of diseases that can make you inadmissible are:

  • diseases that may be subject to quarantine. These have recently included cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, viral hemorrhagic fevers, severe acute respiratory syndromes, pandemic flu. Basically, any diseases that may pose a public health emergency of international concern.

A step by step guide to getting your green card medical exam

Step 1: Download and fill out form I-693

All people filing for Adjustment of Status complete the Green Card Medical Exam on Form I-693. While you can fill out these forms yourself, if you have any questions we strongly suggest getting the advice of a good immigration lawyer to help you. Even small mistakes can cost days, weeks, or even months. Remember, you have to fill out your personal information, and then take the form to be completed by an approved doctor.

Step 2: How do I find a doctor for my I-693 medical exam?

Your family doctor cannot perform this particular medical examination. There are only two types of doctors who can perform the medical exam, and the right one for your situation depends on where you’re applying from:

  • If you’re applying from within the United States, you will see a civil surgeon designated by U.S. Citizenship and Immigration Services (USCIS).
  • If you’re applying from abroad, you will see a panel physician authorized by the U.S. Department of State.

When choosing a doctor, make sure to ask about fees and the doctor’s availability. Fees for civil surgeons vary wildly.

To find a “designated civil surgeon”  United States Citizenship and Immigration Services to do the I-693, click this link to find a doctor now. You can also call the USCIS National Customer Service Center at 800-375-5283.

Step 3: Schedule your medical exam

As of November 1, 2018, there are new regulations on timing your I-693 medical exam. USCIS is now updating the way the current maximum 2-year validity period is calculated to enhance operational efficiencies and reduce the need to request updated Form I-693 from applicants.

The new guidelines state that:

  • A Form I-693 is valid only when a civil surgeon signs it no more than 60 days before the date an applicant files the application for the underlying immigration benefit; and USCIS adjudicates the application within 2 years from the date of the civil surgeon’s signature.
  • Exam results will now be valid for 2 years instead of 1.

This means that you want to make sure you are scheduling your medical exam in conjunction with your green card application, as you only have two months to file after you get your medical exam. You can also apply for your green card without your medical exam, with the intention of getting the exam to complete the application. 

NOTE: If you are applying from outside the US, then you can schedule your immigration medical exam only AFTER you have your green card interview appointment. These results will only be valid for 3-6 months.

Step 4: Make sure you have everything on this Green Card Medical Exam Checklist

  1. Your partially filled out form I-693 (the doctor will fill out his section after the exam)
  2. A list of any vaccines you have had; this has to be an official list and it must be translated into English if it’s in a foreign language.
  3. Prepare a list of any chronic medical conditions you have, or any medication you are taking
  4. If you have been treated or hospitalized for psychiatric or mental illness, or alcohol or drug abuse, you will need to bring written certification from a doctor – including the diagnosis, length of treatment, and your prognosis.
  5. If you have had any history of violent behavior you will need to bring information that will allow the doctor to determine whether the behavior was related to a psychiatric or medical problem, or to drug or alcohol use. Harmful behavior includes attempted suicide or self-harm, no matter how minor in nature.
  6. If you have had syphilis, a written certificate, signed by a doctor or public health official, proving that you were adequately treated.  If you have ever had a positive VDRL or other blood test for syphilis, and were not treated, you must bring a written explanation signed your doctor.
  7. If you or anyone in your immigrating family have any form of disabilities, you should bring a report of their condition, and any requirements they have as far as special education or supervision
  8.  If you have ever tested positive for TB (tuberculosis), you should bring a certificate from your doctor giving the circumstances of the positive test result, indicating any treatment prescribed and how long it lasted, and if proof that you were adequately treated -including dates and types of medications prescribed.
  9. If you have ever had an abnormal chest X-ray, bring the last X-ray films taken. The actual films, not the typed reports, may be required.

Step 5: The exam: what should I expect?

The exam itself is fairly straightforward. The doctor will review your medical history, and then give you a physical examination, chest x-ray and blood test. Children under the age of 15 will normally not have to have the x-ray or blood tests. If you are pregnant you may request that the x-ray be delayed.

The doctor will not give you a general physical exam, nor will he/she be checking for anything that is not related to what is of interest to U.S. immigration authorities. The doctor will basically be looking for any clues of physical or mental behavior that “results in a substantial departure from a normal state of well-being or level of functioning.”

Expect questions about:

  • Medical history including hospitalizations
  • History of drug and alcohol use
  • Any history of mental illness
  • Chest X-rays for tuberculosis
  • Records from police, military, school and employment looking for any history of physical or mental disorders

ALSO:

  • Symptoms that relate to cardiovascular, pulmonary, musculoskeletal, and neuropsychiatric disorders
  • They will look at your eyes, nose, mouth, throat, extremities, heart, lungs, abdomen, lymph nodes, skin, and external genitalia
  • They will draw blood, and you will need to fast for the blood draw
  • Urine test
  • There will also be a mental status examination, assessing your intelligence, thought, comprehension, judgment, affect, mood, and behavior
  • All female applicants must complete the medical exam even if they are having a menstrual period.
  • Pregnant women may postpone the X-ray until after giving birth, but the X-ray must be completed before entering the United States (if applying from abroad) or before completing the green card interview (if applying from within the United States).

Depending on your vaccine history, you can expect to receive any vaccines you might be missing. The doctor then completes the Immigration Medical exam with a sealed “Report of Medical Examination and Vaccination Record.” You must bring a proper medical record of your vaccine history, and it must be translated into English if it’s in another language.

You can then take your sealed report to your visa interview yourself, or will send the results directly to the U.S. embassy or consulate. Remember DO NOT OPEN THE ENVELOPE. It needs to remain sealed until it is given to the proper authorities.

What vaccines will I be expected to get in order to complete my I-693?

  • Diphtheria
  • Tetanus
  • Pertussis
  • Polio
  • Measles
  • Mumps
  • Rubella
  • Rotavirus
  • Haemophilus influenzae type b (Hib)
  • Hepatitis A
  • Hepatitis B
  • Meningococcal disease
  • Varicella
  • Pneumococcal disease
  • Influenza

As more vaccines are created, other diseases may be added to this list. Not everyone will receive all vaccines. Currently babies are only given certain vaccines. Also, you will only be given the vaccines as you are applying for the green card. For a current list of vaccines that are considered age-appropriate, you can go to this link in USCIS. If you have age or medical concerns (like pregnancy) about vaccines you can contact an immigration lawyer and apply for a blanket waiver for medical or age reasons.

 Remember…

  1. You can always get help from an immigration lawyer to understand the reasons for the many questions of the green card medical exam, and help you through your Adjustment of Status.
  2. There are a lot of other requirements to getting a green card. This is just one step.

 

Written by: Harlan York

Immigration Attorney Harlan York is Former Chair, Immigration Section, NJ State Bar Association and Former Co-Chair, NY State Bar Association CFLS Immigration Committee. Mr. York appeared on National Television on CBS This Morning with Charlie Rose and Primer Impacto on Univision, as well as Telemundo, NBC, and PBS. He was honored as First Ever Immigration Lawyer of The Year in NJ by Best Lawyers.

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