Report of Medical Examination and Vaccination Record

Purpose of Form :
Generally, all applicants filing for adjustment of status to that of a lawful permanent resident must submit Form I-693 completed by a designated civil surgeon. Form I-693 is used to report results of a medical examination to the U.S. Citizenship and Immigration Services (USCIS). The examination is required to establish that an applicant is not inadmissible to the United States on public health grounds. A list of those health grounds can be found in section 212(a)(1) of the Immigration and Nationality Act.

Number of Pages :
Instructions: 8; Form: 6.

Edition Date :
10/14/2009. See “Special Instructions” below for important information on previous editions.

Where to File :
After completion of the medical examination, the civil surgeon is required to give you, the applicant, the completed Form I-693 in a sealed envelope. Do not accept it if it is not in a sealed envelope. USCIS will return the form to you if it is not in an envelope or if the envelope has been opened or altered.

You, the applicant, not the civil surgeon, are required to submit the Form I-693 to USCIS.

If you are applying for adjustment of status: Submit Form I-693 together with your Form I-485, Application to Register for Permanent Residence or Adjust Status, as detailed in the instructions to Form I-485.

Other applicants: Follow the instructions on or included with the application for or the instructions given to you by the office requesting the medical examination.

Filing Fee :
$0.00

Special Instructions :
Editions: Current edition is 10/14/2009. Previous editions (Edition 06/05/2008) will be accepted for medical assessments conducted on or before December 31, 2009 only for medical exams conducted on or after November 1, 2009 that utilize the Tuberculin Skin Screening Test (TST). If a civil surgeon utilizes an IGRA test to fulfill the initial TB screening test requirement, the civil surgeon MUST use the October 14, 2009 edition of Form I-693 to record the IGRA result. On or after January 1, 2010, the results of the medical examinations must be recorded on the October 14, 2009 edition of Form I-693 irrespective of the TB test used.

Special Instructions for the Applicant:

The medical examination must be conducted by a physician who has been designated by USCIS as a civil surgeon. A the current list of civil surgeons in your area is available at the Civil Surgeon Locator, at USCIS.gov.

You may also obtain the names and phone numbers of the designated civil surgeons in your area by calling USCIS’ National Customer Service Center at 1-800-375-5283. You will be asked to provide your zip code. Please have a pen or pencil ready to write down the list of civil surgeons in your area.

The civil surgeon is required to complete the medical examination according to the Technical Instructions for the Medical Examination of Aliens in the United States, written by the Centers for Disease Control and Prevention (CDC). It is your responsibility to attend your medical exam appointment and all follow up exams and testing, as may be required by the civil surgeon. Failure to comply with the civil surgeon’s instructions may lead to the civil surgeon’s inability to complete the medical exam, as directed by CDC and USCIS.

To view the Technical Instructions for the Medical Examination of Aliens including the TB and Vaccination Component of the Technical Instructions, please visit CDC’s website.

After the medical examination is completed, the civil surgeon must give you the original and completed Form I-693 in a sealed envelop. Do not open the envelope.

The civil surgeon must also give you a copy of the completed and signed Form I-693 and any supporting documentation submitted to USCIS to you for your records.

Special Instructions for Civil Surgeons:

In order to perform medical examination of aliens, you must be a physician designated by the United States Citizenship and Immigration Services (USCIS) as a Civil Surgeon. If you are not designated, you should seek designation from the USCIS District Office within your jurisdiction. For more information, please visit Designated Civil Surgeons on USCIS.gov.

The medical examination of aliens in the United States must be performed according to CDC’s Technical Instructions for the Medical Examination of Aliens in the United States (Technical Instructions or TIs), published by the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. These Technical Instructions include the following documents:

The Technical Instructions for Medical Examination of Aliens in The United States (1991)
The Tuberculosis Component of Technical Instructions for the Medical Examination of Aliens in the United States (May 2008)
Adjustment of Status for U.S. Permanent Residence Requirements: Technical Instructions for Vaccinations 2008
Any updates to the documents above as published on CDC’s website.
These documents and updates can be obtained from CDC’s website.

CDC does not mail hard copies of these documents; it is the responsibility of the civil surgeon to obtain these documents on-line and to comply with the requirements of the Technical Instructions.

Failure to comply with the Technical Instructions may result in the revocation of civil surgeon designation by USCIS.

Note:

The results of the medical examination are generally valid for only 12 months. Applicants should schedule the medical examination as close as possible to the time they file for adjustment of status, but provide for sufficient time for the performance of laboratory testing or additional testing required under CDC’s Technical Instructions.

This page can be found at http://www.uscis.gov/i-693