The Sealed Envelope Rule Prohibits Electronic Transmission

Form I-693 is a medical document that USCIS requires to be submitted in its original sealed envelope, signed across the flap by the civil surgeon. This requirement — commonly known as the sealed envelope rule — exists to ensure the integrity and authenticity of the medical findings. An emailed or faxed copy of Form I-693 is not the original sealed document and therefore cannot be accepted by USCIS.

When a civil surgeon completes Form I-693, the form is placed inside an envelope that is sealed and signed. This physical seal is the chain of custody mechanism that certifies the form has not been altered since it left the civil surgeon's office. An electronic copy — whether a PDF sent by email, a fax transmission, or a scan — breaks that chain of custody entirely. There is no way to verify the integrity of an electronic copy the way USCIS can verify an intact sealed envelope.

This rule applies regardless of who is requesting the electronic copy. Whether it is the applicant, their immigration attorney, a paralegal, or anyone else — the answer is the same: the sealed envelope cannot be transmitted electronically.

Why Electronic Copies Are Not Accepted

USCIS's requirement for the original sealed envelope is rooted in the need to prevent fraud and ensure that medical findings are accurately reported. Immigration medical examinations are a critical component of the adjustment of status process, and USCIS takes the integrity of these records seriously.

An electronic copy of Form I-693 could be altered, forged, or manipulated in ways that a properly sealed physical envelope cannot. The civil surgeon's signature across the sealed flap, combined with the physical integrity of the envelope, provides a level of security that no electronic transmission can replicate. This is why USCIS has never moved to accept electronic submissions of Form I-693, even as other immigration forms have become available online.

How Attorneys Can Properly Receive Form I-693

Immigration attorneys who need to receive their client's Form I-693 must do so through physical means. The most common approach is for the attorney or a member of their staff to pick up the sealed envelope directly from our clinic on the applicant's behalf, with proper authorization.

If an attorney needs to receive the form by mail, the sealed envelope can be sent via a tracked, secure mail service such as USPS Priority Mail with tracking and signature confirmation, or via a courier service. The key requirement is that the physical sealed envelope arrives intact — not a copy of its contents.

• Attorney or authorized staff picks up the sealed envelope in person at our clinic
• Sealed envelope is mailed via tracked, secure mail service with signature confirmation
• Applicant picks up the form and delivers it to their attorney in person
• Under no circumstances should the envelope be opened before delivery to the attorney
• Contact our office in advance to arrange third-party pickup authorization

What Happens If the Seal Is Broken

If the sealed envelope is opened for any reason — whether accidentally or intentionally — the Form I-693 is considered compromised. USCIS will not accept a form that arrives in an opened or resealed envelope. There is no way to "re-seal" the envelope in a manner that USCIS will accept.

If the seal is broken, the applicant will need to return to the civil surgeon for a new immigration medical examination. This means repeating all required tests, paying the examination fee again, and waiting for a new form to be processed. This is a costly and time-consuming outcome that is entirely avoidable by following the sealed envelope rule.

Proper Chain of Custody From Clinic to USCIS

The chain of custody for Form I-693 runs from the civil surgeon's office to USCIS, with the applicant as the custodian in between. The civil surgeon seals the form, the applicant (or their authorized representative) picks it up and keeps it sealed, and then the applicant submits the sealed envelope to USCIS either with their I-485 filing or at their adjustment of status interview.

Every step in this chain must involve the physical sealed envelope. Any attempt to substitute an electronic copy at any point in the chain breaks the chain of custody and renders the form unacceptable. If you are ever unsure about the proper handling of your sealed Form I-693, contact our office or consult with your immigration attorney before taking any action.