The Medical Examination

In general, applicants for adjustment of status (AOS) are required to submit a medical report and vaccination record. According to U.S. Citizenship and Immigration Services (USCIS), an applicant’s health history serves to ensure he or she is not inadmissible to the United States on public health grounds.

Health and Inadmissibility

Section 212(a)(1) of the Immigration and Nationality Act (INA) enumerates the health-related justifications for determining that an alien is ineligible to receive visas and, therefore, inadmissible to the U.S. According to statute, the following conditions disqualify an AOS applicant:

  1. Communicable diseases “of public health significance,” which are specified by the Centers for Disease Control and Prevention (CDC) and include:

    • Active tuberculosis
    • Infectious syphilis
    • Gonorrhea
    • Infectious leprosy
    • Chancroid
    • Previously, the CDC included HIV in the list, but as of November 2, 2009, the agency no longer characterizes HIV as a communicable disease of “public health significance.” 
  2. Past or present physical or mental disorders and behavior associated with said disorders that “may pose, or has posed, a threat to the property, safety, or welfare of the alien or others”

  3. Drug abuse or addiction


The results of an applicant’s medical report and vaccination record are reported in Form I-693. Importantly, not just any physician is allowed to complete an I-693. Rather, USCIS certifies certain medical doctors as “designated civil surgeons” whose medical reports are exclusively accepted. AOS applicants can locate a designated civil surgeon in their area either by phoning the National Customer Service Center at 1-800-375-5283, or by searching for one online using USCIS’s “Find a Doctor” tool. While there is no separate fee for a completed Form I-693, applicants are required to pay the full price of the medical examination, which generally costs no more than a few hundred dollars; applicants with health insurance should note that their insurance will not cover the exam’s costs.

For the appointment, applicants should bring with them government-issued photo identification (such as a passport) and any documentation of their vaccination history. The medical examination comprises several tests, some of which are not required by applicants of a certain age.

Exam Component

Required by Whom?

Physical examination: evaluation of an applicant’s general health and mental status

All applicants

TB skin test

Applicants 2 years old and older; for children younger than 2 years old, the test is administered if TB is suspected or if the child has had contact with someone with TB

Blood test

Applicants 15 years old and older; for children younger than 15 years old, the test is administered if there is reason to suspect the possibility of blood-borne infection(s)

Vaccinations, if not already administered, for such diseases as:

  • Mumps
  • Measles
  • Rubella
  • Polio
  • Tetanus/diphtheria
  • Pertussis
  • Hepatitis B
  • Influenza (type B)
  • Seasonal flu, if the exam is conducted between October 1 and March 31 (i.e. flu season)
  • Any other vaccinations recommended by the CDC’s Advisory Committee for Immunization Practices (ACIP)

All applicants

However, applicants have the option to file a Form I-601 waiver, should they elect not to be vaccinated on religious or moral grounds and they are choosing not to be vaccinated at all.

Further, note that a designated civil surgeon has the discretion to determine which of the required vaccines is medically appropriate for an applicant. In general, a vaccine is not considered medically appropriate for a person for any of the following reasons:

  1. The vaccination is not recommended for the person’s age group.
  2. A medical condition—e.g., allergies, pregnancy, etc.—prevents the person from being vaccinated.
  3. The person is unable to complete the full series of a required vaccination within a reasonable period of time.

After the medical examination, applicants sign Form I-693 in the presence of their designated civil surgeons, who will subsequently certify the report and seal the completed I-693 in an envelope. The sealed envelope must be left sealed. AOS applicants are required to submit the sealed medical report with their Form I-485 petitions.

The completed medical report is valid for one year prior to filing an AOS application, and remains valid for as long as an applicant’s I-485 is pending with USCIS.

Our Firm is Here to Help

It is important that prospective permanent residents understand that each adjustment case varies as a function of an alien’s unique circumstances. As such, we emphatically recommend retaining an experienced immigration attorney. To begin your potential AOS case, contact Zhang & Associates for an initial free consultation by clicking here.

For more detailed information on adjustment of status, including related issues, refer to the following links:

General AOS Topics

Further Reading on AOS


Updated 08/10/2017