This article is general information, not legal advice. The immigration medical exam is not just a doctor’s appointment. It is a filing-timing and document-handling step that can affect whether USCIS accepts the adjustment package at all.

Outcome and prerequisites

Before you schedule the exam, confirm:

  • whether you need a full Form I-693 or only a partial vaccination record;
  • whether you are filing Form I-485 by mail or online;
  • what vaccination records and identity documents you already have.

Short answer

USCIS says that, effective Dec. 2, 2024, most adjustment applicants must submit Form I-693 with Form I-485, or USCIS may reject the adjustment filing. USCIS also says the exam must be completed by a USCIS-designated civil surgeon unless a specific exception applies.

The civil surgeon must sign the form and place it in a sealed envelope. If you file Form I-485 online, USCIS says you open the envelope to upload the completed I-693 with the online package, but you must still keep the original form and envelope until USCIS makes a final decision.

Step-by-step process

1. Confirm whether you need a full or partial I-693

USCIS lists several groups, such as certain refugees, derivative asylees, and some K-based applicants, that may submit only the vaccination portion in defined circumstances. Do not assume everyone needs the exact same exam package.

2. Use the right doctor

For most adjustment applicants in the United States, the exam must be done by a USCIS-designated civil surgeon. USCIS also recognizes blanket-designated health departments for refugees completing vaccination requirements.

3. Bring the right records

USCIS says you should bring Form I-693, government-issued photo identification, vaccination or immunization records, payment, and any other medical documentation the doctor requests. Missing vaccine documentation can turn into extra shots, extra lab work, or extra appointments.

4. Handle the sealed result correctly

USCIS will not accept a normally required I-693 if the envelope has been opened or altered before the proper submission step. Keep a personal copy, but preserve the original as instructed.

5. Match filing method to the current rule

For paper I-485 filing, USCIS says to submit the sealed original with the application package. For online I-485 filing, USCIS instructs applicants to upload the completed I-693 and keep the original form and envelope for possible later review.

Costs, timing, and required documents

Costs

USCIS does not set one uniform exam price. The Find a Civil Surgeon page says costs can vary significantly by doctor.

Timing

The filing timeline matters as much as the exam itself. The old habit of waiting for an RFE is no longer the safer default for most adjustment applicants.

What the doctor and USCIS care about

  • current identity documentation;
  • vaccination records;
  • CDC-based testing and age-appropriate vaccine requirements;
  • proper civil-surgeon completion and signature;
  • sealed-envelope handling.

Failure cases and alternatives

Using the wrong doctor

An exam from a physician who is not authorized to act as a civil surgeon usually does not solve the filing requirement.

Opening what should stay sealed

USCIS treats sealed-envelope handling seriously. If the document chain is broken at the wrong stage, you may need corrective steps or another submission.

Relying on old timing advice

USCIS now says many applicants must file I-693 together with I-485. Advice based on older “bring it later” assumptions may be outdated.

Arriving with no vaccine evidence

The civil surgeon can only document what is proven, administered, or medically excused under the applicable rules. Missing records often make the visit slower and more expensive.

Checklist

  • Confirm whether you need a full or partial I-693.
  • Book with a USCIS-designated civil surgeon unless a stated exception applies.
  • Bring ID and vaccination records.
  • Follow the correct sealed-envelope rule for paper or online I-485 filing.
  • Keep the original exam materials until USCIS finishes the case.

Sources and update date

Primary sources reviewed 2026-08-03: USCIS Form I-693 guidance, Find a Civil Surgeon guidance, USCIS vaccination-requirements guidance, USCIS Policy Manual Volume 8 Part B Chapter 4, and CDC civil-surgeon vaccination instructions.