What USCIS Officers Look for When Accepting Form I-693

Before accepting Form I-693, the USCIS officer will perform a basic review of the envelope and form. The officer checks that the envelope is sealed and intact, that the civil surgeon's signature appears on the outside of the envelope, that the form edition is current, and that the form was completed by a USCIS-designated civil surgeon.

If any of these checks fail, the officer will decline to accept the form and will note the deficiency in the record. The interview may continue on other grounds, but the medical exam component will be held open pending a valid submission.

Most Common Reasons USCIS Rejects Form I-693

The most frequent rejection causes attorneys encounter are:

• Broken or tampered seal — the envelope was opened after the civil surgeon sealed it
• Wrong edition — the form was completed on an outdated edition that USCIS no longer accepts
• Missing civil surgeon signature on the envelope exterior
• Form I-693 expired — submitted more than two years after the civil surgeon's signature date, or more than four years after the medical exam date under newer validity rules
• Civil surgeon not USCIS-designated at the time of the exam
• Applicant brought the form unsealed or in a plain envelope rather than the original sealed civil surgeon envelope

What Happens Immediately After Rejection

When the officer rejects Form I-693, the officer will typically note the reason on the record and advise the applicant (or attorney of record) of the deficiency. The officer will not issue a formal RFE at the interview itself — the rejection is an in-person administrative action.

In some cases, the officer will issue a written notice after the interview specifying what is needed and providing a deadline for submission. In other cases, the officer will simply hold the case open and expect the applicant to submit a corrected form promptly.

If the attorney is present at the interview, this is the moment to ask the officer to clarify the specific deficiency in writing so there is no ambiguity about what must be corrected.

How to Respond After a Rejection

The response depends on the reason for rejection:

If the seal was broken: the applicant must return to the civil surgeon for a new exam. The civil surgeon cannot simply re-seal the original form — a new Form I-693 must be completed.

If the edition is wrong: the applicant must return to the civil surgeon to complete the exam on the current edition. Depending on how recently the exam was performed, the civil surgeon may be able to re-examine the applicant and complete a new form without repeating all components.

If the form is expired: the applicant must undergo a new immigration medical exam. The civil surgeon will complete a new Form I-693 with a current date.

If the civil surgeon was not USCIS-designated: the applicant must undergo a new exam with a properly designated civil surgeon. This is one of the most serious rejections because it cannot be corrected without a full new exam.

Prevention: The Attorney Pre-Submission Checklist

Most Form I-693 rejections are preventable. Before the interview, attorneys should verify:

• The envelope seal is intact and unbroken
• The civil surgeon's signature appears on the outside of the sealed envelope
• The form edition matches the current USCIS-required edition
• The civil surgeon is currently USCIS-designated (verify on the USCIS civil surgeon locator)
• The form is within its validity window — check the civil surgeon's signature date against current USCIS validity rules
• The applicant has not opened the envelope at any point