USCIS's report of the immigration medical exam that most adjustment-of-status applicants must file with Form I-485. A designated civil surgeon checks for communicable diseases of public health significance, physical or mental disorders with harmful behavior, drug abuse or addiction, and required vaccinations, following the CDC Technical Instructions. The signed form goes to the applicant in a sealed envelope and stays valid for two years from the civil surgeon's signature.
The applicant completes Part 1 and signs Part 2 in the civil surgeon's presence, with interpreters and preparers using Parts 3 and 4. The civil surgeon completes Parts 5 through 10, and a health department or doctor receiving a required referral fills out and signs Part 9.
Record the form of government-issued photo identification the applicant presented, such as a passport or driver's license, and its document number. Check that the name and A-Number at the top of every page match Part 1. Have the applicant sign Part 2 in your presence at the start of the exam, after Parts 1 through 5 are complete.
Enter the date of first examination, which must be the date the applicant signed Part 2 and gave permission for the exam and testing, plus any follow-up exam dates. Then select one overall finding: no Class A or Class B condition, Class B conditions, or Class A conditions, matching the worksheet items in Part 8.
Give your name, Civil Surgeon Identification Number (CSID) unless you work under a health department or military blanket designation, practice name, addresses and contact details. Sign only after all health-related follow-up is met, certifying under penalty of perjury that you hold a valid, unrestricted license and followed the CDC Technical Instructions. Health departments and military facilities add their official stamp or seal.
Tuberculosis: report the IGRA (QuantiFERON or T-Spot) for applicants 2 and older, chest X-ray dates and findings when required, sputum smears and cultures, and the TB classification. Syphilis and gonorrhea: report test names, dates and results for the CDC age ranges printed on the form, with any treatment. Hansen's disease: record findings by classification and treatment status.
Classify any physical or mental disorder by whether harmful behavior is current, likely or unlikely to recur, using DSM or ICD criteria. Classify drug abuse or addiction involving controlled substances as Class A, or as Class B when in full remission. List other Class B conditions, such as hypertension or diabetes, with the required evaluation components.
Complete only when a referral is medically required, not merely recommended. Name the doctor or health department, give the referral date, and use Remarks to state the condition, the reason for referral and the tests or treatment needed. Keep a copy and give the original to the applicant in a sealed envelope, unsigned, until the referral is finished.
Completed by the health department or doctor who received the referral. They confirm they evaluated or treated the applicant named in Part 1 after verifying identity, then give their name or health department name, address, practice name, daytime phone, signature and date. Extra details go in Part 11.
Mark every row. Transfer dates from written records, record vaccines you give, mark a series complete, or note a lab date for immunity or VH for varicella history. Use the blanket waiver columns for not age-appropriate, contraindication, insufficient time interval or unavailable influenza or COVID-19 vaccine, then select the result and give the applicant a copy.
Download the current version from the source each time; forms change without notice.
Report of Immigration Medical Examination and Vaccination Record
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Sources for this guide
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The instructions state that Form I-693 remains valid for two years from the date of the civil surgeon's signature. The applicant must also keep the original form and the civil surgeon's envelope until USCIS makes a final decision on Form I-485, because USCIS may ask for them at an interview or as evidence.
No. Only a doctor designated by USCIS as a civil surgeon may perform the exam, with limited exceptions for blanket-designated health departments and military physicians. USCIS will not accept a form completed by a doctor who is not currently designated. Applicants can search the USCIS Find a Doctor tool or ask a doctor to confirm their designation.
Only after the exam and every required follow-up or referral is complete and the applicant is medically cleared. Before a referral, enter your details in Part 7 but leave the signature and date blank. The signature must be original; stamped or typed names are rejected, except for blanket-designated health departments and military physicians.
No. The form is published in English only, although USCIS runs a Spanish information page about it. Any foreign-language document submitted with the form needs a full English translation with a translator's certification of completeness, accuracy and competence, including the translator's signature, printed name, date and contact information.