The Sealed Envelope Rule

Form I-693 must be submitted to USCIS in the sealed envelope provided by the civil surgeon. The civil surgeon signs the outside of the envelope and the seal must remain intact. If the envelope is opened for any reason — including attorney review — the form is invalidated and a new exam must be performed.

This rule means attorneys cannot directly review the completed Form I-693 before submission. However, attorneys can review a copy of the applicant's medical records, which contain the same underlying information that the civil surgeon used to complete the form.

How to Obtain a Copy of the Medical Records

To review the medical records, the attorney needs the applicant's written HIPAA authorization. The authorization should specifically identify the civil surgeon's clinic as the covered entity and authorize the release of records related to the immigration medical exam.

With the authorization in hand, the attorney can request a copy of the medical records directly from the clinic. Our clinic can provide a copy of the examination records, vaccination documentation, and laboratory results. Contact us at 714-760-4538 or through our online portal to submit a records request.

Review the records promptly after the exam — before the interview is scheduled if possible — so there is time to request corrections if errors are identified.

What to Look for in the Medical Records

When reviewing the medical records, attorneys should check for the following common error categories:

• Applicant identifying information — name spelling, date of birth, and A-number must match exactly what appears on the immigration application
• Vaccination record completeness — confirm all required vaccines are documented, including any multi-dose series with correct dates for each dose
• Missing vaccines — identify any required vaccines that are not documented and determine whether they were administered, deferred, or contraindicated
• Lab results — confirm that all required laboratory tests (syphilis, TB) were performed and that results are documented
• TB evaluation — confirm the TB test type, result, and whether a chest X-ray was performed or deferred
• Civil surgeon designation — verify that the civil surgeon is currently USCIS-designated
• Dates — confirm that the exam date and any follow-up dates are accurately recorded

How to Request a Correction

If the medical records reveal an error, the attorney should contact the civil surgeon's clinic promptly. Minor errors — such as a misspelled name or incorrect date — can often be corrected by the civil surgeon without requiring a new exam.

The civil surgeon will need to open the sealed envelope, make the correction, and re-seal the form. The civil surgeon must initial and date any corrections made to the form. A corrected and re-sealed form is valid for submission.

For more significant errors — such as a missing required vaccine or an incorrect clinical finding — the civil surgeon will need to evaluate the applicant again before correcting the form. Contact the clinic to discuss the specific error and the appropriate correction process.

The Pre-Submission Checklist

A systematic pre-submission review should cover:

• Applicant name and date of birth match the immigration application exactly
• A-number is correct (if applicable)
• All USCIS-required vaccines are documented with dates
• Any deferred or contraindicated vaccines are noted with reasons
• TB test type and result are documented
• Chest X-ray performed or deferral reason documented
• Syphilis test result documented
• Civil surgeon signature and USCIS designation number present
• Sealed envelope intact with civil surgeon signature on exterior
• Form edition is current
• Form is within its validity window