Digital vs. Paper Immunization Records for Your I-693

For a USCIS Form I-693 exam, a written record with the month, day and year of every dose is what counts, and the final sealed I-693 itself is a physical document. A vaccine app, a patient-portal summary or your own memory of your shots does not replace either one. Digital records can still help. They are often the fastest way to find the dates that you then bring to your civil surgeon in a form the surgeon can review.

This guide explains where digital and paper records each fit in the immigration medical process, what the CDC and USCIS say, and how to assemble a record that gets accepted the first time.

TL;DR

• The civil surgeon needs a written vaccination record showing the month, day and year of each dose. Verbal or self-reported histories are not accepted.
• Digital sources such as state registries are useful for finding dates, but the burden of providing documented proof stays with you.
• The completed Form I-693 is handed to you signed in a sealed envelope. If you file Form I-485 online, you upload a scan but must keep the original form and envelope until USCIS makes a final decision.
• Start collecting records before your appointment, from every clinic, school and country where you were vaccinated.

Table of Contents

• Two different questions: the vaccine record and the I-693 itself
• What USCIS says about the sealed form
• What the civil surgeon can accept as vaccination proof
• Paper vs. digital records side by side
• Why digital records are often incomplete
• Records from outside the United States
• What happens if you have no record at all
• How to build your record before the appointment
• Common mistakes we see
• Our perspective
• If you need an exam in Southern California
• Choosing where to get your exam
• FAQ
• Sources

Two different questions: the vaccine record and the I-693 itself

People searching “digital vs paper immunization” are usually mixing up two separate documents, and the rules differ for each.

1. The proof of past vaccinations you bring to the exam. This is the evidence of doses you already received.
2. The Form I-693 the civil surgeon completes. This is the official report that goes to USCIS, and it includes the vaccination record section.

The first is an input. The second is the output. Digital copies can play a role in the first, with limits. For the second, USCIS describes a signed form in a sealed envelope, and that is the version you keep as your original.

What USCIS says about the sealed form

When you file Form I-485 to adjust status, you must also submit Form I-693. According to USCIS, the civil surgeon gives you a completed, signed form in a sealed envelope. Do not accept the form from the surgeon if it is not sealed.

If you file the I-485 online, you open the envelope and upload the completed I-693 with your application. You then have to keep the original form and the envelope until USCIS makes a final decision on the I-485. USCIS may review them at an interview or ask you to send them as evidence.

That last point matters. A scan or photo on your phone is a convenience for filing. It is not a substitute for the original. If you want a deeper look at how the rule changes depending on how you file, see our article on sealed versus electronic I-693 submissions. Spanish speakers can read the same topic in I-693 digital o papel.

USCIS also states that, effective December 2, 2024, you must submit the I-693, or a partial I-693 such as the vaccination record, together with your I-485. Otherwise the I-485 may be rejected. Check the current instructions on the USCIS I-693 page before you file, since filing rules change.

What the civil surgeon can accept as vaccination proof

The CDC’s Technical Instructions for civil surgeons say the surgeon reviews the documentation you provide and, if it appears valid, records the vaccination history and any vaccines given at the exam on the I-693. Acceptable documentation is a written record, such as a personal vaccination card or a copy of a medical chart, with the date of each dose. Records must be legible and must not appear altered.

In practice, that means:

• Paper that works: a yellow childhood vaccination card, a school immunization record, a clinic printout of your chart, a military or employer health record, or an official record from a foreign health authority.
• Digital that may work as a source: a record you pull from a state registry or a healthcare provider’s patient portal, printed or shown in full, with dates for every dose. Whether it appears valid is the civil surgeon’s call, so bring it printed and complete.
• What does not work: a statement that you are “up to date,” a parent’s recollection, or an app screenshot that shows only that a vaccine was given with no dates.

We cannot promise that any single digital format will be accepted by every surgeon. What we can say is that a legible written record with full dates is the standard in the CDC instructions, and anything that falls short of it invites a delay.

Paper vs. digital records side by side

The honest summary: paper is more portable proof, digital is a better search tool. Most successful applicants use both.

Why digital records are often incomplete

The CDC explains that Immunization Information Systems, or IIS, are confidential, computerized, population-based databases that record doses given by participating providers in a geographic area. Two limits follow from that definition.

First, they only hold what participating providers reported. If you were vaccinated before the registry existed, in another state, in another country or by a clinic that did not report, the entry may be missing.

Second, there is no national database. The CDC says it does not hold vaccination record information and points people to their state or jurisdiction’s IIS. If you have lived in several places, you may need to contact more than one.

The CDC also notes that changing vaccination providers often leads to incomplete records because data is not always shared between healthcare systems. It advises people to keep personal vaccination records from birth.

If you live in California, the state health department offers a My Vaccine Record portal where residents can access their COVID-19 vaccine record from the state registry. That page describes COVID-19 records, so do not assume it will show your childhood shots. For other vaccines, ask your past providers or your county or state immunization program.

For a broader view of why vaccine histories scatter across different medical offices, this primary care guide to adult vaccine schedules explains how a single visit can be used to review what you have and what you are missing. It is written for patients in New Jersey, so treat the local details as specific to that state.

Records from outside the United States

Many adjustment applicants were vaccinated abroad. The same written-record rule applies. The CDC’s civil surgeon FAQ makes clear that K visa applicants who did not complete a series overseas cannot simply say they are up to date. They must obtain valid written records, for example by contacting the original provider, or be vaccinated according to the Technical Instructions during the exam.

Practical tips for foreign records:

• Ask family members to photograph or scan the original booklet, including every page with stamps.
• Check that dates are readable and written in a format you can explain. A day-month-year order is common abroad, and the surgeon will want to read it correctly.
• If a clinic abroad can email a certified copy, ask for one. Do not edit, retype or fill in missing dates yourself. Records that appear altered are a problem.
• If records cannot be found, tell the civil surgeon up front. Re-vaccination or titer testing may be options. Our guide to accepted vaccine titers covers when a blood test can stand in for missing documentation.

What happens if you have no record at all

This is more common than people expect. You do not need to cancel your exam. Civil surgeons are authorized to give the required vaccines at a single visit, and the CDC instructs them not to hold up the exam over minimum interval times when a vaccine is not medically appropriate or is contraindicated. In those cases blanket waivers are used instead.

Only vaccines listed in the Technical Instructions are required for the adjustment exam, and they must be age appropriate under the ACIP recommendations for the general U.S. population. Not every vaccine you may have heard of is needed. Our walkthrough on clearing MMR for the I-693 in one visit shows what that looks like for one common requirement, and our piece on adult polio vaccination and the I-693 (in Spanish) covers another.

If you are on medication, pregnant or have a medical condition that affects a vaccine, say so at the start. A vaccine decision is a medical decision made by the surgeon, not something to guess about from a website.

How to build your record before the appointment

Treat this like a short research project and give yourself a week or two if you can.

1. List every place you may have been vaccinated. Pediatricians, schools, public health clinics, pharmacies, employers, the military, and clinics in other countries.
2. Find any paper you already have. Look for the childhood card, passport-sized health booklets, college health forms and old school records.
3. Query your registry. Use the CDC’s IIS contact page to find your state or jurisdiction and see how to request your record.
4. Request chart copies. Ask past doctors for a printout of your immunization history showing dates.
5. Print, do not paraphrase. Print digital records in full. A screenshot that cuts off the dates will not help.
6. Bring everything, even duplicates. Overlapping records are fine. Gaps are the problem.
7. Check the form edition and your other results. Beyond vaccines, small paperwork details cause requests for evidence, which is why we wrote about checking edition, vaccines and seal.

Common mistakes we see

• Bringing a phone screenshot that shows only “complete” with no dates.
• Assuming a registry holds records from before you moved to the state.
• Typing missing dates into a form by hand.
• Opening the sealed I-693 for a paper filing. For a paper I-485 package, follow the USCIS instructions on the I-693 page and do not open the envelope.
• Throwing away the original sealed envelope after scanning it for an online filing.
• Expecting results from a closed case to carry over. See why I-693 results cannot follow a closed case to a new filing.

Our perspective

Since 2007 our practice has done one thing: USCIS Form I-693 immigration medical exams. We do not run a primary care or urgent care clinic, so every visit we see is built around the Technical Instructions and the form.

The question we hear most is whether a digital record will do. Our answer is to treat digital as the way you find the dates and paper as the way you prove them. A civil surgeon is not allowed to go on your word, and a general doctor’s habit of asking “are you up to date?” does not apply here. The CDC’s instructions favor written, date-specific documentation because it is the only thing the surgeon can verify before signing something that USCIS will rely on.

We frequently help applicants who come to us after delays, errors, incomplete vaccination documentation or problems with an exam done elsewhere. The cause is nearly always the same: the vaccine record was assembled late, or the sealed form was handled in a way that did not fit the filing method. Both are avoidable.

Our advice is simple. Collect early, print everything, bring it all, and tell us what you cannot find. We can review what you have, give required vaccines when appropriate, and arrange titer testing in the same location, so a gap in your records does not turn into a second trip.

— ImmigrationMedicalExams Medical Team

If you need an exam in Southern California

We serve applicants across Southern California, including Los Angeles, Orange, Riverside, San Diego and San Bernardino counties, with 24/7 online scheduling. The USCIS Immigration Medical Exam for Form I-693 includes the civil surgeon exam, lab testing, vaccination review and vaccines when appropriate, and preparation of the form, using a flat-package approach meant to limit surprise costs. Processing is about three days as standard, or two days with the expedited option. Not sure what the visit involves? Read what happens at an immigration medical exam. Add-ons such as titer testing, extra vaccinations and replacement sealed envelopes are listed on our pricing page.

Choosing where to get your exam

If you are comparing options, the main alternatives are a general doctor who also serves as a civil surgeon, a large medical group, or a practice that does only immigration exams. Ask each of them the same questions:

• Can you review my vaccine records and give any missing vaccines at the same visit?
• Is lab testing done on site or sent elsewhere, and how does that affect turnaround?
• How is the sealed envelope handled, and what happens if it is damaged or lost?
• What is included in the price, and what costs extra?
• Do you check the form for errors before sealing it?

Our guide to choosing an I-693 clinic goes through these criteria in more detail. A missed appointment deposit of $210 applies at our practice, so schedule when you can attend.

FAQ

Can I use a digital vaccine record for my I-693?

A digital record can be a source for the dates, but the civil surgeon needs documentation showing the month, day and year of each dose and has to judge whether it appears valid. Bring a complete printout rather than a summary screen. Verbal or self-reported histories are not accepted.

Do I need to keep the paper I-693 if I file my I-485 online?

Yes. USCIS says you must keep the original Form I-693 and the sealed envelope from the civil surgeon until it makes a final decision on your I-485. You upload a scan, but USCIS may ask to see the originals at an interview or request them as evidence.

Does the CDC keep a national record of my vaccines?

No. The CDC says it does not have vaccination record information. Records sit with state or local immunization information systems and with your providers, so you may need to contact more than one source if you have moved.

What if I lost my vaccination card?

Start with your past doctors, schools and your state or local registry, then bring whatever written proof you find. If records cannot be recovered, the civil surgeon can advise on re-vaccination or titer testing under the CDC Technical Instructions. You can still keep your exam date while you look.

Sources

• USCIS: Report of Immigration Medical Examination and Vaccination Record (I-693)
• CDC: Vaccination, Technical Instructions for Civil Surgeons
• CDC: Vaccination Technical Instructions FAQs for civil surgeons
• CDC: Immunization Information Systems, About
• CDC: Contacts for IIS Immunization Records
• CDC: Vaccination Records
• CDPH: My Vaccine Record

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• 2026 I-693: Avoid RFEs by Checking Edition, Vaccines, and Seal