I-693 Blood Tests: 3 Screens U.S. Applicants Must Document
Form I-693 requires three blood or lab-based screenings for most applicants: an IGRA blood test for tuberculosis for anyone 2 years or older, syphilis serology for applicants in specified age ranges, and a gonorrhea NAAT for applicants in specified age ranges. Civil surgeons order these tests during the exam itself, following CDC Technical Instructions, and record the results directly on the form.
TL;DR:
- Applicants aged 2 and older need an IGRA for tuberculosis; a positive result requires chest imaging, and signs of active disease can lead to sputum testing.
- Civil surgeons order required tests during the appointment, and outside lab results cannot replace them; bring numeric syphilis titers if previously treated.
- Gonorrhea screening uses a urine or swab NAAT, with testing based on CDC age brackets; symptoms or known exposure can justify testing outside them.
- A reactive syphilis screen requires confirmation because initial results can be false positives; HIV screening is not part of the exam.
- IGRA results typically arrive within 72 hours, while exam components must be less than one year old when the civil surgeon signs the form.
Table of Contents
- Checklist: required blood tests and quick summary
- What each test screens for, how samples are collected, and typical result outcomes
- Who needs each test and common exceptions
- How results appear on Form I-693 and how long they take
- How to prepare for the blood tests
- Costs, insurance, and typical processing timelines
- How a dedicated I-693 clinic runs blood testing and avoids common documentation problems
- Medical team perspective: final practical recommendation
- Book your I-693 exam online
- FAQ
- Sources
Checklist: required blood tests and quick summary
Most applicants preparing for a civil surgeon visit want a fast answer to “what will they test me for.” Here is the short version before we get into the details.
- Tuberculosis: an IGRA blood draw for applicants 2 years and older, with a chest x-ray if the result is positive.
- Syphilis: a nontreponemal screening test, followed by a confirmatory treponemal test when the screen is reactive.
- Gonorrhea: a nucleic acid amplification test (NAAT), ordered at the time of the exam for applicants in the required age brackets.
Civil surgeons also screen for other communicable diseases of public health significance as part of the standard protocol, but HIV is not one of them. HIV was removed from the list of inadmissible conditions in 2010, and civil surgeons do not test for it as part of an I-693 exam, according to the CDC civil surgeon guidance. Every test result above gets entered on the appropriate part of Form I-693, and the tests themselves are ordered at the visit rather than accepted from outside paperwork.
What each test screens for, how samples are collected, and typical result outcomes
Each required test has its own collection method, timeline, and follow-up path.
IGRA for tuberculosis uses a blood draw rather than a skin test. Civil surgeons must use an FDA-approved IGRA product, such as QuantiFERON or T-SPOT, and follow the manufacturer’s collection and interpretation instructions. Results are typically available within 72 hours, a turnaround that shapes how quickly the rest of the exam can move forward, according to CDC’s technical instructions. A positive IGRA triggers a chest x-ray, and if the x-ray suggests active disease, sputum samples must go to a public health lab or a lab designated by the health department for culture and drug susceptibility testing.
Syphilis testing follows a two-step algorithm: a nontreponemal screening test first, then a treponemal confirmatory test if the screen comes back reactive. The second test matters because nontreponemal tests can produce false positives, and the CDC syphilis technical instructions require confirmation before a civil surgeon can classify an applicant. Applicants who were already treated for syphilis should bring numeric titers from that treatment, since those numbers help the civil surgeon document resolved infection rather than active disease.
Gonorrhea screening uses a NAAT, run on a urine sample or a swab depending on the collection method the clinic uses. Civil surgeons must order this test at the exam itself rather than relying on any prior result, per USCIS guidance on gonorrhea reporting.
Who needs each test and common exceptions
Age brackets determine which tests apply to which applicants, though civil surgeons retain some discretion.
- IGRA is required for applicants 2 years and older, with pediatric cases handled under the same CDC protocol.
- Syphilis serology applies within the age ranges set by CDC’s technical instructions, though a civil surgeon may test outside that range when clinical judgment supports it.
- Gonorrhea NAAT applies within its own CDC-specified age brackets, and symptoms or known exposure can lead a civil surgeon to test even when age alone would not require it.
In every case, the civil surgeon decides whether circumstances justify testing beyond the standard age ranges, based on the applicant’s history and presentation at the exam.
How results appear on Form I-693 and how long they take
Civil surgeons record tuberculosis, syphilis, and gonorrhea results in the corresponding parts of Form I-693, and the exam components must be less than one year old at the time the civil surgeon signs the form, per the USCIS I-693 instructions.
- IGRA results usually return within approximately three days, which sets the pace for the rest of the exam.
- When eMedical applies, certain tuberculosis classifications must be entered within five business days of the civil surgeon signing the form, and IGRA or chest x-ray files may need to be uploaded as PDFs.
- USCIS has clarified when lab reports must accompany the form for gonorrhea results, so applicants should confirm current requirements with their civil surgeon rather than assume older rules still apply.
For a full walkthrough of how the appointment itself unfolds, our step-by-step guide to the immigration medical exam covers what happens before, during, and after testing.
How to prepare for the blood tests
A little preparation prevents most of the delays we see tied to blood-test documentation.
- Bring a government-issued photo ID and any vaccination records you already have.
- Bring numeric syphilis titers or proof of prior treatment if you have been treated before, since civil surgeons need documented numbers rather than a verbal history.
- Disclose any past treatment for syphilis or gonorrhea honestly, since this affects how the civil surgeon classifies the result.
- Follow any collection instructions your clinic provides, including avoiding recent antibiotic use before a gonorrhea NAAT when possible.
Pro Tip: Civil surgeons generally cannot accept outside lab results for I-693 reporting, since the tests must be ordered as part of the exam itself, so skip bringing old results and focus on treatment documentation instead.
Our checklist of ID requirements and our guide to syphilis treatment documentation go deeper into exactly what paperwork to gather before your appointment.
Costs, insurance, and typical processing timelines
Exam pricing varies by clinic and by whether lab work is bundled into a flat package or billed separately, and insurance coverage for immigration exams varies by plan, so it is worth confirming coverage with your insurer and your civil surgeon before the visit.
- Flat-package pricing tends to bundle the civil surgeon visit, required labs, and vaccine review into one predictable cost.
- A standard exam often completes in about three days, while an expedited two-day option exists for applicants under a filing deadline.
- IGRA turnaround of roughly 72 hours is usually the pacing factor behind both timelines.
Our guide to I-693 costs without insurance breaks down savings strategies for applicants paying out of pocket.
How a dedicated I-693 clinic runs blood testing and avoids common documentation problems
We have specialized exclusively in immigration medical examinations and Form I-693 since 2007, with no primary care, urgent care, or sick visits mixed into our practice. We run tuberculosis, syphilis, and gonorrhea testing on site, review vaccination records, and complete the form under our standard 3-day processing or a 2-day expedited option when timing is tight. Because we work with prior treatment documentation daily, including numeric syphilis titers, we help applicants avoid the requests for evidence that incomplete lab paperwork often causes. Once testing and review are complete, the civil surgeon signs and seals the I-693 for USCIS submission.
Medical team perspective: final practical recommendation
Bring your treatment records, plan for IGRA’s roughly 72-hour turnaround, and consider an expedited option if your filing deadline is close. We built our practice around this exact workflow, and online scheduling is open 24/7 for applicants who need to move quickly.
— ImmigrationMedicalExams Medical Team
Book your I-693 exam online
We offer a straightforward flat-package approach built to avoid surprise charges, with a standard 3-day exam for most applicants and a 2-day expedited exam for tighter deadlines. For lab credentialing questions on cases involving outside testing, AABB lab verification explains why accreditation matters for legal and immigration use.
- USCIS Immigration Medical Exam, Form I-693: full exam, labs, and vaccine review in one visit.
- Pricing and add-on services: titer testing, additional vaccinations, and sealed envelope replacements.
Scheduling is available online 24/7, and our team is glad to answer questions about test coverage or prior-treatment documentation before your visit.
This article is general information, not a substitute for advice from a qualified doctor. Consult a qualified healthcare professional about your own circumstances before acting on anything here.
FAQ
What medical tests are done for I-693?
Civil surgeons perform a physical exam, review vaccination records, and run required lab testing, which includes an IGRA blood test for tuberculosis, syphilis serology, and a gonorrhea NAAT for applicants in the specified age ranges. Results are then recorded directly on Form I-693.
What blood tests are done for U.S. immigration?
The blood-based tests required for immigration medical exams are the IGRA for tuberculosis and syphilis serology, both ordered by the civil surgeon during the exam. Gonorrhea screening is also required but is typically run as a urine or swab NAAT rather than a blood draw.
What are the most common I-693 errors?
Common errors include missing numeric syphilis titers for applicants with prior treatment, incomplete vaccination records, and lab results that were not ordered directly by the civil surgeon. Exam components older than one year at the time of signing also cause rejections, per USCIS I-693 instructions.
How much does an I-693 medical exam cost?
Cost varies by clinic depending on whether the civil surgeon visit, labs, and vaccines are bundled into a flat package or billed separately, and insurance coverage for immigration exams varies by plan. We recommend confirming your exact cost and any insurance coverage directly with the clinic before booking.