Immunocompromised and Need an I-693? What Changes
Being immunocompromised does not disqualify you from a green card, and it does not give you a different form. You still need a Form I-693 signed by a USCIS-designated civil surgeon. What changes is how two parts of the exam are handled: tuberculosis (TB) screening, where you may need a chest X-ray even with a negative blood test, and vaccinations, where the civil surgeon can mark a vaccine as “not medically appropriate” so USCIS waives it. This guide explains both, what to bring, and how to avoid the delays that trip up applicants with complex medical histories.
TL;DR
- An immunocompromising condition, including HIV, is not by itself a reason for medical inadmissibility. Active, communicable (Class A) TB is.
- Known HIV infection or TB symptoms means a chest X-ray is required, whatever your TB blood test says.
- Vaccines that are unsafe for you can be marked contraindicated by the civil surgeon, and USCIS waives them without a separate application.
- Bring every medical and vaccination record you have, plus a list of your medications, to the first appointment.
- Choose a civil surgeon who handles complex files regularly, so the I-693 is complete before it is sealed.
Table of Contents
- Does being immunocompromised change the I-693 exam?
- Is an immunocompromising condition a reason for inadmissibility?
- How immunocompromise affects TB screening
- What happens if the TB results are abnormal or incomplete
- Vaccinations: contraindications and waivers
- What to bring to your appointment
- Common mistakes that cause delays
- Our perspective
- Get an I-693 exam from a civil surgeon who only does I-693s
- FAQ
- Sources
Does being immunocompromised change the I-693 exam?
The exam has the same parts for everyone: a medical history and physical, TB screening, blood testing for syphilis, a vaccination review, and the civil surgeon’s completion of the form. Being immunocompromised does not add a new section. It changes the decisions inside two of those parts.
First, TB screening. Immune suppression can make standard TB tests unreliable, so the rules for when a chest X-ray is needed are stricter for some immunocompromised applicants. Second, vaccination. Some required vaccines, especially live ones, may be unsafe, and the form has a way to record that.
Immunocompromised can mean many things: HIV, cancer treatment, an organ transplant, long-term steroids, or biologic drugs for autoimmune disease. The civil surgeon needs to know which applies to you, because the answer determines which vaccines are safe and how a TB result should be read. Tell the doctor about every diagnosis and every medication at the start of the visit, not after the results come back.
Is an immunocompromising condition a reason for inadmissibility?
No. USCIS policy treats an applicant as medically inadmissible on health grounds for communicable diseases such as Class A TB, defined by current CDC guidelines as TB that is clinically active and communicable, according to the USCIS Policy Manual chapter on communicable diseases. A weakened immune system is not on that list.
HIV deserves a specific note because many applicants still worry about it. The CDC explains that a final rule published on November 2, 2009 removed HIV infection from the list of inadmissible conditions for immigration purposes. Immigration Equality also describes how, after January 4, 2010, HIV was no longer a reason to deny a green card. If you want more detail on how HIV fits into the exam, our Spanish-language article on whether the HIV test is required for the I-693 walks through it.
The practical point is that HIV status matters to the exam for a medical reason, not an admissibility one: it affects TB screening, as described next.
How immunocompromise affects TB screening
All applicants 2 years of age or older must have an initial TB screening test. Children under 2 are exempt unless they have signs or symptoms suggestive of TB or a known HIV infection, per the USCIS Policy Manual. The usual screening test is an interferon-gamma release assay (IGRA), a blood test. For the full workflow, see our guide to TB screening for Form I-693.
Why a negative test may not be enough
The reason immunocompromise matters is simple: the tests rely on your immune system reacting. The National Society of TB Clinicians’ 2025 clinical guide states that altered immunity from immunosuppression can cause false-negative results in both the skin test (TST) and IGRA. The same guide notes that using both tests together can increase sensitivity for detecting TB infection in immunocompromised patients.
That is why the immigration rules do not let a negative blood test close the question in every case.
When a chest X-ray is required
Per the CDC’s Technical Instructions for Civil Surgeons, a chest X-ray is required for applicants with:
- a positive IGRA,
- known HIV infection,
- signs or symptoms of TB disease, or
- extrapulmonary TB.
The same instructions state that if you have signs or symptoms of TB, you must have a chest X-ray regardless of whether your IGRA is positive or negative. So if you are living with HIV, expect an X-ray as a standard part of your exam. If you take immunosuppressive medication and have a cough, night sweats, weight loss or fever, say so: those symptoms trigger the X-ray even when the blood test is normal.
An X-ray requirement is not an accusation of TB. It is a precaution built into the process, and most applicants who need one have a clear result.
| Situation | Chest X-ray required? |
|---|---|
| Negative IGRA, no symptoms, no known HIV | Not required on these grounds |
| Positive IGRA | Yes |
| Known HIV infection, any IGRA result | Yes |
| TB signs or symptoms, any IGRA result | Yes |
| Extrapulmonary TB | Yes |
What happens if the TB results are abnormal or incomplete
This is where delays occur, so it helps to understand the sequence. Under the USCIS Policy Manual, applicants with chest X-ray findings suggestive of TB, signs or symptoms of TB, or known HIV infection must be referred to the health department for sputum testing, and the civil surgeon cannot sign until the required TB steps are complete. That rule is in the communicable diseases chapter.
In plain terms:
- The civil surgeon sees an abnormal X-ray, or your history requires the extra step.
- You are referred to the local health department for sputum testing.
- The health department reports results back, and any treatment decision follows.
- Only after those steps are done can the civil surgeon complete and sign the I-693.
If active TB is found, treatment comes first. Indian Health Service clinical guidance notes that immunocompromised patients are typically treated with a 9-month course of daily therapy, with monthly sputum checks until results are negative. Treatment length is a medical decision made by your treating clinicians and the health department, not by the immigration clinic.
Two points on cost and planning. USCIS instructs that the applicant pays all costs of the exam, including any follow-up tests or treatment. And because outside steps can take time, do not wait until your interview or filing deadline to start the exam if your history is complex.
Vaccinations: contraindications and waivers
The I-693 includes a vaccination assessment. Under the USCIS vaccination policy, each age-appropriate vaccine must be marked as received or as not medically appropriate, and USCIS waives vaccines marked not medically appropriate.
What “not medically appropriate” means for you
The same chapter says some vaccines are not medically appropriate for applicants with an immunocompromising condition, such as HIV/AIDS or a weakened immune system from certain medications, and the civil surgeon may mark them as contraindicated. Two details help you:
- No separate waiver application is needed for a vaccine marked not medically appropriate.
- The civil surgeon may note the reason in the remarks section, but if the reason is left out, an officer does not need to issue a Request for Evidence for that omission alone, as long as the contraindication is marked in the vaccine chart.
The key phrase is “marked in the vaccine chart.” A contraindication that is discussed in the exam room but not recorded correctly can still cause problems. Review the vaccine page before the envelope is sealed.
Which vaccines might be affected
Which vaccines are unsafe depends on your diagnosis, your CD4 count if you have HIV, and your medications. That is a clinical judgment for the civil surgeon, not something an article can settle. Live-virus vaccines such as MMR are the ones people most often ask about. If you are unsure whether you are already immune to measles, mumps or rubella, a blood titer can answer that without a vaccine; our piece on clearing MMR for the I-693 in one visit explains the options.
Do not skip a vaccine because you assume it is unsafe. Ask the civil surgeon to decide and to document the decision.
What to bring to your appointment
USCIS instructs applicants who have medical or vaccination records to take them to the first appointment. For an immunocompromised applicant, a good folder includes:
- Vaccination records from any country, including childhood cards.
- A current medication list with doses, including steroids, biologics, chemotherapy or transplant drugs.
- A letter or recent notes from your specialist (infectious disease, oncology, rheumatology, transplant) stating your diagnosis and treatment.
- Prior TB test results, chest X-rays and any TB treatment records.
- Syphilis test and treatment records if you have ever been treated. Numeric titers matter; see our guide on syphilis treatment records for the I-693.
- Government ID and, if you have it, your prior I-693 edition information.
If your records are in another language, they usually need a full English translation to be accepted. Translation errors are a known cause of requests for evidence, and the guidance on translation-related RFEs shows what a properly documented translation involves.
Common mistakes that cause delays
Applicants with complex medical histories run into the same problems repeatedly.
A vaccine left blank. If a vaccine is neither recorded as given nor marked not medically appropriate, the form is incomplete. Make sure each line is resolved.
Skipping the specialist letter. A civil surgeon who has never seen your specialist’s notes has to make decisions with less information. A short letter can save a second visit.
Seeing a provider who is not a civil surgeon. A primary care doctor or an urgent care clinic may be excellent clinically but cannot sign an I-693 unless designated. Our article on whether urgent care can do an immigration medical exam explains the distinction.
Signature and seal problems. Opening the sealed envelope or getting a signature in the wrong place can invalidate the form. See I-693 signature requirements.
Wrong form edition or timing. Checking the edition and the date of signature matters; our guide to avoiding RFEs by checking edition, vaccines and seal covers it. USCIS also updated its policy in June 2025 so that a Form I-693 is generally valid only for the period the related benefit application is pending. Confirm current timing guidance with your attorney or on USCIS.gov before choosing your exam date.
Our perspective
We have performed only immigration medical exams since 2007. We do not run a primary care or urgent care practice, so the I-693 is not a side task squeezed between sick visits.
For immunocompromised applicants, that focus matters in specific ways. The decisions that count are made inside the exam: whether a chest X-ray is needed, whether a vaccine should be marked contraindicated, and whether the vaccine chart says exactly what the medical record says. We designed our process around doing those steps correctly the first time, with an internal quality review before the form is sealed.
We also see applicants who come to us after an exam elsewhere left a vaccine unresolved, a titer missing, or a TB step incomplete. Most of those problems are preventable with a complete set of records and a clear conversation about medications at the start.
Our approach is a flat-package structure meant to limit surprise costs, with standard processing in about 3 days and a 2-day expedited option. If your history requires outside steps, such as a health department referral, we will tell you what has to happen before the form can be signed.
ImmigrationMedicalExams Medical Team
Get an I-693 exam from a civil surgeon who only does I-693s
We serve applicants throughout Southern California, including Los Angeles, Orange, Riverside, San Diego and San Bernardino counties. Our USCIS immigration medical exam covers the civil surgeon exam, on-site lab testing, vaccination review and needed vaccines, and preparation of the I-693. Choose the standard 3-day exam or the 2-day expedited option, and book online at any hour.
If you are immunocompromised, add a note about your diagnosis and medications when you schedule. Costs for titers, extra vaccines and replacement envelopes are listed on our pricing page. For what happens on the day itself, read what to expect during a USCIS medical examination.
FAQ
Can I get a green card if I have HIV?
Yes. HIV infection was removed from the list of inadmissible conditions for immigration purposes by a rule that took effect in 2010. You will still have the same I-693 exam, and known HIV means a chest X-ray is part of the TB screening. Talk with your immigration attorney about the rest of your case.
Do I have to get vaccines if my immune system is weak?
Not if the civil surgeon decides a vaccine is not medically appropriate for you. The doctor marks it as contraindicated on the form, and USCIS waives it without a separate application. Vaccines that are safe for you are still required.
Will a negative TB blood test be enough?
Only if you have no known HIV and no TB signs or symptoms. Known HIV infection or TB symptoms means a chest X-ray is required whatever the IGRA result. Your civil surgeon will explain which applies to you.
What if my chest X-ray looks abnormal?
The civil surgeon refers you to the health department for sputum testing and cannot sign the I-693 until the required TB steps are complete. Many abnormal findings turn out not to be active TB, but the process must be finished. You pay for follow-up tests and any treatment.
Should I tell the civil surgeon about my medications?
Yes, at the start of the visit. Steroids, biologics, chemotherapy and transplant drugs can affect both TB test accuracy and vaccine safety. Bring a written medication list and a letter from your specialist.
Sources
- USCIS Policy Manual, Volume 8, Part B, Chapter 6: Communicable Diseases of Public Health Significance
- USCIS Policy Manual, Volume 8, Part B, Chapter 9: Vaccination Requirement
- CDC Technical Instructions for Civil Surgeons: Tuberculosis
- CDC Technical Instructions for Civil Surgeons
- Instructions for Form I-693
- USCIS policy update on validity of Form I-693
- Tuberculosis Infection in the United States, clinical guide (February 2025)
- Indian Health Service Chest Clinic Guidelines
- Immigration Equality: People Living with HIV
- USCIS RFE caused by bad translation