What Is Form I-693?

Form I-693 (Report of Medical Examination and Vaccination Record) is the official USCIS form used to document the results of the immigration medical exam. It is completed exclusively by a USCIS-designated civil surgeon — not by the applicant's personal physician. The form captures the results of the physical examination, mental health screening, vaccination review, and required laboratory testing.

Who Must Submit Form I-693?

Form I-693 is required for most applicants seeking adjustment of status to lawful permanent resident (green card) within the United States. It is also required for certain other immigration benefits. Applicants applying for an immigrant visa at a U.S. consulate abroad undergo a separate medical examination through a panel physician — not a civil surgeon.

Children under 15 must complete the full exam, including vaccinations. Applicants 75 and older are exempt from the influenza vaccine requirement. Certain religious exemptions may apply to vaccination requirements.

Structure of Form I-693

Form I-693 has several parts: Part 1 (applicant information), Part 2 (civil surgeon certification), Part 3 (medical examination results), Part 4 (vaccination record), and Part 5 (civil surgeon signature and stamp). Each part must be completed in full — incomplete sections are a leading cause of RFEs.

The civil surgeon must use the current edition of the form. USCIS periodically updates Form I-693, and submissions on outdated editions are rejected. Attorneys should verify that the civil surgeon is using the current edition before the exam.

Validity Windows — The Two-Year Rule

Form I-693 has a two-year validity window from the date the civil surgeon signs the form. USCIS will not accept a Form I-693 that was signed more than two years before the date USCIS receives it. This is a hard deadline — there is no grace period.

Additionally, the form must be signed no more than 60 days before the applicant files Form I-485 (Application to Register Permanent Residence). Attorneys should coordinate the timing of the medical exam carefully to ensure the form is valid when USCIS receives it.

If a Form I-693 expires before USCIS adjudicates the case, the applicant must undergo a new examination. This is a common issue in cases with long processing times. Attorneys should monitor validity windows and proactively schedule re-examinations when necessary.

The Sealed Envelope Protocol

After completing the exam, the civil surgeon seals Form I-693 in an envelope, signs across the seal, and stamps the envelope with the civil surgeon's official stamp. The applicant must deliver the sealed envelope to USCIS — either at an interview or by mail with Form I-485.

The envelope must remain sealed. If the envelope is opened before USCIS receives it, the exam is invalid and the applicant must undergo a new examination. Attorneys should instruct clients not to open the envelope under any circumstances.

Attorneys may request a copy of Form I-693 for their files before the envelope is sealed. This is standard practice and does not affect the validity of the sealed envelope.

Common Errors That Trigger RFEs

The most common Form I-693 errors that trigger RFEs include: (1) outdated edition of the form, (2) missing civil surgeon stamp on the sealed envelope, (3) incomplete vaccination record, (4) missing laboratory results, (5) civil surgeon signature missing or illegible, (6) incorrect or missing applicant information, and (7) form submitted outside the validity window.

Attorneys can reduce RFE risk by reviewing the sealed envelope before the client leaves the civil surgeon's office. Verify that the envelope is properly sealed, signed across the seal, and stamped. If any of these elements are missing, ask the civil surgeon to correct the issue before the client departs.

Class A vs. Class B Findings

The civil surgeon's findings are classified as Class A or Class B. A Class A finding indicates a condition that makes the applicant inadmissible — active tuberculosis, a communicable disease of public health significance, a mental disorder with associated harmful behavior, or failure to present vaccination documentation. Class A findings must be resolved before the applicant can be admitted.

A Class B finding indicates a condition that does not make the applicant inadmissible but requires follow-up after admission — typically inactive tuberculosis or other TB-related findings. Class B applicants are admitted with a condition requiring follow-up treatment.

When to Schedule the Exam

Attorneys should schedule the immigration medical exam after Form I-485 is ready to file but no more than 60 days before filing. For cases with long USCIS processing times, attorneys should monitor the two-year validity window and schedule a re-examination if the form is approaching expiration. Priority scheduling is available for urgent cases.