Two Distinct Medical Exam Processes

The immigration medical exam is required for all applicants seeking lawful permanent residence, but the specific process depends on whether the applicant is adjusting status inside the United States or going through consular processing abroad.

These are two entirely separate systems with different forms, different physicians, different submission procedures, and different validity rules. A medical exam completed for one process cannot be used for the other. Attorneys must ensure their clients understand which process applies to their case and follow the correct procedure.

Adjustment of Status: Form I-693 and Civil Surgeons

For applicants adjusting status inside the United States, the medical exam is conducted by a USCIS-designated civil surgeon. The civil surgeon completes Form I-693, seals it in an envelope, and provides it to the applicant for submission to USCIS.

Key characteristics of the adjustment of status medical exam:

• Physician: USCIS-designated civil surgeon (find one at uscis.gov/civil-surgeons)
• Form: Form I-693 (Report of Immigration Medical Examination and Vaccination Record)
• Submission: Sealed envelope submitted to USCIS at or before the adjustment of status interview
• Validity: Generally two years from the civil surgeon's signature date
• Location: Performed in the United States

Consular Processing: DS-2054 and Panel Physicians

For applicants going through consular processing abroad, the medical exam is conducted by a panel physician designated by the U.S. Embassy or Consulate in the applicant's country. The panel physician completes Form DS-2054 (Medical Examination for Immigrant or Refugee Applicant), not Form I-693.

Key characteristics of the consular processing medical exam:

• Physician: U.S. Embassy/Consulate-designated panel physician (find one at travel.state.gov)
• Form: Form DS-2054 (not Form I-693)
• Submission: Results transmitted directly to the U.S. Embassy or Consulate — not submitted by the applicant
• Validity: Generally one year from the date of the medical examination
• Location: Performed in the applicant's country of residence or the country where the consular interview is scheduled

Critical Differences Attorneys Must Know

The most important practical differences for attorneys are:

Wrong physician: A civil surgeon cannot perform the consular processing exam, and a panel physician cannot perform the adjustment of status exam. Using the wrong type of physician means the exam results will not be accepted.

Wrong form: Form I-693 is for adjustment of status only. Form DS-2054 is for consular processing only. The forms are not interchangeable.

Submission procedure: For adjustment of status, the applicant brings the sealed Form I-693 to the USCIS interview. For consular processing, the panel physician transmits the results directly to the consulate — the applicant does not handle the medical exam results.

Validity period: The consular processing exam is generally valid for one year, which is shorter than the two-year validity for adjustment of status. Timing is more critical for consular processing cases.

When a Client Switches from Consular Processing to Adjustment of Status

If a client who was in consular processing switches to adjustment of status (for example, after entering the United States on a nonimmigrant visa), the consular processing medical exam results cannot be used for the adjustment of status application. The client must undergo a new medical exam with a USCIS-designated civil surgeon and complete Form I-693. This is a common source of confusion and delay — attorneys should advise clients of this requirement as soon as the switch to adjustment of status is confirmed.