Why Vaccination Records Are Critical

Vaccination documentation is one of the most important components of the immigration medical examination. USCIS requires that all applicants meet the vaccination requirements set by the Advisory Committee on Immunization Practices (ACIP). The civil surgeon must review your vaccination history and document it on Form I-693. Missing or incomplete records can result in additional vaccines being administered, titer testing being ordered, or a follow-up appointment being required.

Bringing complete vaccination records to your appointment is the single most effective way to streamline the process. The more documentation you have, the less likely you are to need additional vaccines or tests — and the faster your Form I-693 can be completed.

Gathering Records From Multiple Sources

Vaccination records can come from many different sources, and you may need to contact several of them to compile a complete history. Start with your current primary care physician, who may have records of vaccines administered in adulthood. If you had a pediatrician in the United States, contact that office as well — childhood vaccination records are often stored for many years.

If you attended school in the United States, your school district may have vaccination records on file. Many states require proof of vaccination for school enrollment, and those records are sometimes retained by the school or district health office.

For vaccines received abroad, gather any health booklets, vaccination cards, or medical records from your country of origin. These documents are accepted by civil surgeons even if they are in a foreign language — bring them as-is, and the civil surgeon will review them.

• Current primary care physician
• Previous pediatricians or family doctors
• School health records (K–12 and college)
• Foreign vaccination booklets or health cards
• Military health records (if applicable)
• State immunization registry

Using Your State Immunization Registry

Most U.S. states maintain an immunization information system (IIS), also called an immunization registry, that tracks vaccines administered by healthcare providers in that state. If you have received vaccines in the United States, your records may be stored in your state's registry even if you no longer have the original documentation.

To access your state's immunization registry, contact your state or county health department. In California, the registry is called the California Immunization Registry (CAIR). You can request a copy of your immunization history from CAIR through your healthcare provider or by contacting the registry directly. Processing times vary, so request your records as early as possible before your appointment.

Keep in mind that state registries only capture vaccines administered by providers who report to the registry. Vaccines given in other states or countries, or by providers who do not participate in the registry, may not appear. Use the registry as one source among many, not as a definitive record.

Organizing Your Records by Vaccine Type

Once you have gathered records from all available sources, organize them by vaccine type before your appointment. Group records for each vaccine together — for example, all MMR (measles, mumps, rubella) records in one section, all hepatitis B records in another, and so on. This makes it easier for the civil surgeon to quickly review your history and identify any gaps.

If you have records in multiple formats — paper cards, printed records, and digital documents — bring all of them. A clear, legible copy is acceptable if you do not have the original. If records are in a foreign language, bring them anyway; the civil surgeon is experienced in reviewing foreign vaccination documents.

What to Do If Your Records Are Incomplete

Incomplete vaccination records are very common, especially for applicants who have lived in multiple countries or who received vaccines many years ago. Do not let incomplete records prevent you from scheduling or attending your appointment. The civil surgeon has several options for addressing gaps in your vaccination history.

If records for a specific vaccine are missing, the civil surgeon may administer the vaccine at your appointment. For vaccines where immunity can be demonstrated through a blood test — such as measles, mumps, rubella, varicella, and hepatitis B — the civil surgeon may order titer testing. A positive titer result demonstrates immunity and can substitute for vaccination records.

In some cases, if you are certain you received a vaccine but cannot locate documentation, the civil surgeon may accept a self-reported history for certain vaccines, depending on USCIS guidelines at the time of your examination. However, written documentation is always preferred.

What the Civil Surgeon Looks For

The civil surgeon reviews your vaccination records against the ACIP-recommended vaccination schedule for your age group. They are looking for documentation of each required vaccine, including the number of doses received and the dates of administration. For multi-dose vaccines — such as hepatitis B, HPV, and the primary series vaccines — the civil surgeon will verify that the correct number of doses was received at appropriate intervals.

The civil surgeon is also looking for vaccines that are age-appropriate. Not all vaccines are required for all age groups — for example, certain vaccines are only required for applicants under a certain age. Bring your complete vaccination history regardless of your age, and let the civil surgeon determine which vaccines apply to your situation.