What Is the Sealed Envelope Rule?
After completing Form I-693, the Civil Surgeon places the completed form inside an envelope, seals it, and signs their name across the seal. This sealed envelope must be submitted to USCIS intact — unopened and undamaged. USCIS will open the envelope themselves when they process your case.
The rule applies to every Form I-693, without exception. It is not optional, and there is no workaround.
Why it matters: The sealed envelope is USCIS's chain-of-custody mechanism. It ensures that the Form I-693 USCIS receives is exactly the form the Civil Surgeon completed — unaltered and unmodified.
Why USCIS Requires a Sealed Envelope
The sealed envelope rule exists to protect the integrity of the medical exam process. Form I-693 contains sensitive medical information — physical exam findings, lab results, vaccination history, and the Civil Surgeon's certification. USCIS requires the sealed envelope to:
Prevent Tampering
Prevents tampering with the form after the Civil Surgeon signs it.
Preserve Certification
Ensures the Civil Surgeon's certification remains intact and unaltered.
Chain of Custody
Maintains a clear chain of custody from the Civil Surgeon to USCIS.
Protect Medical Privacy
Protects the applicant's confidential medical information during transit.
What the Civil Surgeon Does
The Civil Surgeon follows a specific sealing process to ensure the envelope meets USCIS requirements. Here is what happens step by step:
- 1
Completes and reviews Form I-693 for accuracy and completeness.
- 2
Places the completed form inside a standard envelope.
- 3
Seals the envelope.
- 4
Signs their name across the sealed flap — the signature spans both the envelope body and the flap, so any opening would break the signature.
- 5
Provides the sealed envelope to the applicant for submission to USCIS.
Note: The Civil Surgeon's signature across the seal is what makes the envelope tamper-evident. If the envelope is opened, the signature is broken — and USCIS will immediately know the envelope was opened.
What You Must Do (and Must Not Do)
Once you receive the sealed envelope from the Civil Surgeon, your responsibilities are clear. Follow these guidelines carefully.
DO
- Accept the sealed envelope from the Civil Surgeon.
- Inspect the outside of the envelope to confirm it is sealed and signed.
- Store it flat in a safe, dry location.
- Submit it to USCIS as soon as possible.
- Bring it to your USCIS interview if submitting in person.
DO NOT
- Open the envelope under any circumstances — even "just to check."
- Bend, fold, or crease the envelope.
- Expose it to moisture, heat, or humidity (can break the seal).
- Leave it unsealed or attempt to reseal it yourself.
- Mail it without adequate protection (use a rigid mailer).
Warning: Opening the envelope — even accidentally — invalidates Form I-693. USCIS will not accept an opened envelope. You will need a completely new immigration medical exam.
How to Store the Envelope Safely
Best practices for storing the sealed envelope between receiving it and submitting it to USCIS:
Store it flat
Do not fold or bend the envelope. Keep it completely flat to protect the seal and the form inside.
Keep it cool and dry
Store it in a cool, dry location away from moisture and direct sunlight. Humidity and heat can break the adhesive seal.
Use a rigid folder or document sleeve
Place it inside a rigid folder or document sleeve to protect it from accidental bending or creasing.
Avoid temperature extremes
Do not store it in a car, garage, or anywhere with temperature extremes. Heat and cold can compromise the envelope seal.
Submit as soon as possible
Submit it to USCIS as soon as possible — the longer you hold it, the greater the risk of accidental damage.
Tip: Most patients submit their sealed Form I-693 within days of receiving it. The sooner you submit, the less risk of accidental damage.
What to Do If the Envelope Is Opened or Damaged
If the envelope is accidentally opened or damaged before submission, take these steps immediately:
- 1
Do not attempt to reseal it yourself.
- 2
Contact the Civil Surgeon's office immediately.
- 3
The Civil Surgeon may be able to issue a corrected, resealed envelope under specific USCIS-approved procedures — but this is not always possible.
- 4
In most cases, a damaged or opened envelope means you need a new immigration medical exam.
Contact our office immediately if your sealed envelope is damaged or opened. We will advise you on the fastest path forward — including same-day appointments for urgent cases. Call 714-760-4538
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Medical & Legal Disclaimer: The information on this page is provided for general educational purposes only and does not constitute medical or legal advice. Immigration medical exam requirements, USCIS policies, and Form I-693 procedures may change without notice. Always consult a USCIS-designated Civil Surgeon and a qualified immigration attorney for guidance specific to your individual case.