The I-485 medical exam is filed on Form I-693. It covers your vaccination history and screens for a handful of health conditions USCIS checks before approving a green card. The rules shifted three times in under a year, and most sites haven't caught up with any of it.
Last updated June 2026: reflects USCIS policy through June 2025 (PA-2025-08) and the CDC Technical Instructions dated March 11, 2025.
What is Form I-693 and who needs it?
Form I-693 is the report a USCIS-designated doctor fills out after examining you. It documents your vaccination record and screens for the health-related grounds of inadmissibility under INA 212(a)(1). Most people filing Form I-485 to adjust status need one.
You complete the applicant portions of the 14-page form, including your information and certification, and you sign it when the civil surgeon instructs you to do so. The doctor, called a civil surgeon, completes the medical sections, then signs and seals it (USCIS Form I-693 page). There is no USCIS filing fee for Form I-693; you pay the civil surgeon directly. USCIS currently uses the 01/20/25 edition of Form I-693.
3 things that changed for 2026 (what most websites get wrong)
If you've read older guides, you may have picked up facts that no longer hold. Three things changed.
The COVID-19 vaccine is no longer required. USCIS waived it for adjustment applicants effective January 22, 2025 (USCIS alert), and the CDC removed it from the civil surgeon instructions on March 11, 2025 (CDC).
Form I-693 no longer has a fixed expiration, but it is now single-use. A form signed on or after November 1, 2023 has no calendar expiration date, but it's valid only for the specific application you file it with (PA-2025-08). Sites that say "valid for two years" are wrong. So are sites that say "never expires."
You must file the exam with your I-485, not after. Since December 2, 2024, USCIS can reject the entire package if a required Form I-693 is missing (USCIS). Mailing it separately or bringing it to the interview no longer works.
| Common myth | The 2026 fact |
|---|---|
| You still need the COVID-19 shot | Waived for adjustment applicants since Jan 22, 2025; removed by CDC Mar 11, 2025 |
| Form I-693 is good for two years | No fixed expiration, but valid only for the single application it is filed with |
| You can submit the exam later or at the interview | It must be filed with your I-485 since Dec 2, 2024, or the package can be rejected |
| Any doctor can sign it | Only a USCIS-designated civil surgeon |
| A TB skin test is fine | An IGRA blood test is required for applicants age 2 and older |
I-485 vaccination requirements in 2026
The CDC sets the binding vaccination instructions for civil surgeons, and USCIS records the requirement in 8 USCIS-PM B.9. Required vaccines cover age-appropriate doses of:
- Measles, mumps, and rubella (MMR)
- Polio (IPV), expanded on May 1, 2024 so anyone age 2 months or older who is not up to date needs at least one dose
- Tetanus, diphtheria, and pertussis (DTaP, Td, or Tdap by age)
- Haemophilus influenzae type b (Hib), for early childhood
- Hepatitis A and Hepatitis B
- Rotavirus, for infants
- Meningococcal, pneumococcal, varicella, and seasonal influenza
Not every vaccine applies to you. The civil surgeon determines which ones are age-appropriate for your situation. Lab evidence of immunity (titers) counts for MMR, hepatitis A, hepatitis B, polio, and varicella if you don't have written records (CDC).
A missing required vaccine without a valid waiver is a Class A condition, which makes you inadmissible until you correct it (8 USCIS-PM B.9). Blanket waivers (age-inappropriate, medically contraindicated) get noted on the form without a separate filing. A religious or moral objection requires an individual waiver on Form I-601.
What happens during the immigration medical exam
It's fairly routine. The civil surgeon reviews your medical history, does a physical, and completes a mental-status assessment (CDC). Specific screening tests are also part of the visit:
- Tuberculosis: an IGRA blood test for everyone age 2 and older. The TB skin test has not been accepted since October 1, 2018. A chest X-ray is required if the IGRA is positive, if you have known HIV infection, if you have signs or symptoms of tuberculosis disease, or if you have extrapulmonary tuberculosis (CDC).
- Syphilis: a blood test for applicants age 18 to under 45 (CDC).
- Gonorrhea: a test for applicants age 18 to 24, ordered at the time of the exam (CDC).
The doctor also screens for drug or alcohol use and mental conditions tied to harmful behavior. Results fall into Class A (active TB, infectious syphilis, drug addiction, a missing required vaccine, or a disorder with harmful behavior), which makes you inadmissible, or Class B, which gets noted but doesn't block your case on its own (42 CFR Part 34).
I-693 validity: how long is it good for?
Most outdated advice gets this wrong. A current Form I-693 has no calendar expiration, but its validity is tied to a single application. If the application you filed it with gets withdrawn or denied, the form is no longer valid and you'd need a new exam for any future filing (PA-2025-08).
Two exceptions still apply. A form signed before November 1, 2023 keeps the old two-year-from-signature rule. And certain Operation Allies Welcome Afghan parolee medical documentation has special validity rules: USCIS says some OAW medical examinations documented on Form I-693 at a government-run facility after arrival may be used indefinitely, while certain overseas panel-physician exams may be used if completed no more than four years before filing to adjust status and the other USCIS conditions are met. Safest move: schedule the exam close to when you actually file. Don't get it done months early and assume it will hold.
How to find an I-693 civil surgeon
Only a USCIS-designated civil surgeon (or in limited cases, a blanket-designated health department) can complete Form I-693. Your regular doctor can't sign it unless they hold that specific designation. Use the USCIS Find a Civil Surgeon locator or call 800-375-5283. The list updates weekly.
Bring your photo ID, vaccination records, and any prior medical records that might be relevant. When the civil surgeon finishes, they seal the form in an envelope. Don't open it if you're filing by mail. If USCIS's online filing system is available for your specific I-485 category, follow the current online filing instructions for uploading Form I-693 and retaining the original.
How Much Does the I-485 Medical Exam Cost?
USCIS does not set or regulate the price, so it varies by clinic and by which labs and vaccines you need. Most applicants pay between $200 and $500, though it can run higher with extra vaccines. Here is a rough breakdown:
| Item | Typical cost |
|---|---|
| Physical exam and paperwork | $200 to $350 |
| Lab tests (TB, syphilis, gonorrhea) | $100 to $300 |
| Vaccines, if needed | $0 to $600 |
| Total (common range) | $200 to $500 |
These are clinic-reported figures, not government fees. By comparison, many applicants pay an attorney $2,000 or more to prepare a full adjustment package. Guided self-filing sits between hiring a lawyer and doing everything alone. You can also review how Immiva works before deciding. For the separate USCIS form fees, see our guide on how to pay USCIS filing fees.
Timing and submission
The exam has to go in with your I-485, so schedule it before you file. Most clinics return lab results in three to five business days and the sealed form within about a week. Plan around that window.
If USCIS rejects a package (not the same as a denial) and returns it with an opened envelope, you can resend it with the opened original plus a copy of the rejection notice (USCIS). For the full filing process, see how to file Form I-485 and I-485 processing time.
Conclusion
The I-485 medical exam is less complicated than the conflicting advice online makes it look. For 2026: no COVID-19 shot, an IGRA blood test for TB for applicants age 2 and older, a single-use Form I-693 with no calendar expiration for forms signed on or after November 1, 2023, and one firm rule, file it with your I-485 if Form I-693 is required for your category. Get those right and this step rarely causes trouble. If you want a clear path, Immiva's guided filing can help you assemble the package, and our adjustment of status guide covers the rest.
Official sources
This guide is based on current USCIS policy, CDC technical instructions, and federal regulations, verified as of June 2026:
USCIS resources
- USCIS Form I-693 Official Page
- Form I-693 (01/20/25 PDF)
- Form I-693 Instructions
- USCIS Policy Manual, Vol. 8, Part B
- Vol. 8, Part B, Ch. 2 (Class A/B conditions)
- Vol. 8, Part B, Ch. 4 (validity review)
- Vol. 8, Part B, Ch. 9 (vaccination requirement)
- PA-2025-08 (June 11, 2025, single-application validity)
- USCIS alert: COVID-19 vaccine waiver (Jan 22, 2025)
- USCIS Vaccination Requirements
- Find a Civil Surgeon
CDC Technical Instructions for Civil Surgeons
Federal regulations and statutes
- INA 212(a)(1) - health-related inadmissibility
- 8 CFR Part 232 - examination by a civil surgeon
- 42 CFR Part 34 - medical examination of aliens; Class A/B definitions
Immigration law changes frequently. We monitor USCIS policy updates and revise this guide when regulations change.