If you file Form I-485, Application to Register Permanent Residence or Adjust Status, you typically must undergo an immigration medical examination and receive vaccinations against vaccine-preventable diseases. The examination must be done by a doctor who is designated by U.S. Citizenship and Immigration Services. USCIS designates certain doctors (known as civil surgeons) to perform the immigration medical examination required for most green card applicants. The civil surgeon that conducts your medical examination and review of your vaccination records will then prepare a Form I-693 which will serve as evidence of your compliance with this requirement.

A NEW USCIS POLICY requires that an applicant for permanent residency submit a completed Form I-693 WITH their Form I-485 application for adjustment of status or the application will be rejected.

WHO CAN PERFORM AN IMMIGRATION MEDICAL EXAMINATION AND COMPLETE THE FORM I-693?

 Immigration medical examinations conducted inside the United States must be performed by a civil surgeon who has been designated by USCIS. (Immigration medical examinations conducted outside the United States must be performed by a panel physician who is authorized by the Department of State.). For more information on immigration medical examination, see Form I-693, Report of Medial Examination and Vaccination Record and USCIS Policy Manual Guidance on Health- Related Grounds of Inadmissibility.

HOW CAN I FIND A CIVIL SURGEON IN MY AREA to PERFORM THE MEDICAL EXAMINATION AND COMLETE THE FORM I-693?

USCIS has a excellent tool on their website which allows you to search for civil surgeons by location and language spoken, so you can find a designated civil surgeon to complete your medical examination who is not only close to you but speaks your language. Further, you can narrow your search down by gender. This is a really great feature they added as it makes the unpleasant task of going to the doctor much more comfortable when you can pick a doctor in your neighborhood who you can communicate with easily…it’s a trip to the amusement park but it makes the process less uncomfortable.

To find a designate civil surgeon in your area use the tool on the top of this webpage.

What Exactly is the Examination?

The immigration medical examination entails a review of your medical history and a physical examination.

The civil surgeon will review your medical history and then perform a basic physical examination. As part of the physical examination the civil surgeon will test for communicable diseases such as tuberculosis, syphilis, and gonorrhea, depending on age, as required by the Centers for Disease Control and Prevention (CDC). 

After the immigration medical examination, the civil surgeon will complete the Form I-693 and seal the form in an envelope for you to submit to USCIS. They usually stamp the envelope across the fold to ensure the seal is not broken before it is submitted to USCIS. Be careful with the sealed envelope and before you leave the office ensure that it is completely sealed shut. USCIS will not accept the form if the envelope has been opened or altered.

It is strongly recommended that you ask the civil surgeon for an extra copy of the completed Form I-693 for your personal records before the civil surgeon seals the original in the envelope. You can review that copy prior to submitting the sealed envelope, so if you notice the civil surgeon made any mistakes (spelling of your name, date of birth, etc.) you can go have it corrected so it will not delay your application.

You can find all the details about the Form I-693 on the USCIS website at uscis.gov/i-693.

WHAT TO BRING TO YOUR EXAMINATION

Bring the following to your medical examination:

• Form I-693, Report of Medical Examination and Vaccination Record
• Government-issued photo identification, such as a valid passport or driver’s license. If you are 14 years old or younger, bring identification that shows your name, date and place of birth and parent’s full name. Possible forms of identification include your birth certificate (with an English translation) or an affidavit.
• Vaccination or immunization record (such as DT, DTP, DTaP, Td, Tdap, OPV, IPV, MMR, Hib, hepatitis A, hepatitis B, varicella, pneumococcal influenza, rotavirus and meningococcal disease, and COVID-19)
• Health insurance card. You should ask if the civil surgeon accepts your medical plan for immigration medical examinations. Many health insurance plans do not cover all portions of this examination.
• Payment (check with the civil surgeon’s office about acceptable forms of payment). It may be helpful to call a few civil surgeons to find out how much they charge for the immigration medical examination. Prices can vary by several hundred dollars.

Vaccination Requirements

These Questions and Answers provide basic information about the general vaccination requirements for immigrants (this page does not address the vaccination assessments conducted by panel physicians overseas).

For refugees applying for adjustment of status, health department physicians may complete only the vaccination record portion of Form I-693, Report of Medical Examination and Vaccination Record, as blanket-designated civil surgeons.

WHAT VACCINATIONS AM I REQUIRED TO GET?

WILL IMMIGRATION FORCE ME TO GET ALL OF THESE VACCINATIONS?

No. No Government agency will force you to get any vaccinations. It is your decision whether or not you wish to get vaccinated, however, should you choose not to get the required vaccinations then you will not be admitted to the US as a legal permanent resident–your application will be denied.

HOW CAN MY APPLICATION BE DENIED BECAUSE OF VACCINATION RECORDS?

Under the Immigration and Nationality Act (INA) section 212(a)(1)(A)(ii), a noncitizen who seeks admission as an immigrant or who seeks adjustment of status to that of a lawful permanent resident, who fails to show proof that they were vaccinated against vaccine-preventable diseases, is inadmissible and therefore ineligible for admission or adjustment of status.

IF I WAS VACCINATED FOR THESE THINGS ALREADY DO I HAVE TO GET THE VACCINATION AGAIN?

Since the law was designed to protect the health of the public rather than to waste vaccines and money, the answer is no. The civil surgeon will review your vaccination records at the time of your immigration medical examination to see whether you have proof of required vaccinations against vaccine-preventable diseases that are appropriate for your age category. It is important that you take any written vaccination documentation you may have to the civil surgeon when you have your immigration medical examination.

WHAT IF I AM PREGNANT?

 If you are pregnant, the CDC’s Technical Instructions direct the civil surgeon how to evaluate the vaccines you are able to receive during pregnancy. If the civil surgeon cannot safely administer a required vaccine, they will annotate the Form I-693 by marking the vaccine as contraindicated. See the CDC “Guidelines for Vaccinating Pregnant Women” page for information on pregnancy and vaccinations in general.

If the Technical Instructions mandate that a specific vaccine is not contraindicated by pregnancy, but you want to wait to receive the vaccine until after your pregnancy, you may choose to delay the completion of your immigration medical examination until that time. Once you receive the required vaccine(s) and all other requirements, the civil surgeon can then sign and complete your immigration medical examination. Be aware that doing this will almost certainly delay the processing of your application.

WHO IS PAYING FOR ALL THESE VACCINES?

The immigrant applicant is required to pay for the costs of their mandatory vaccinations. Before you ask, the rates vary by civil surgeon, location, and day of the week². You might want to call several local civil surgeons to compare fees. For more information on how to obtain a good faith estimate prior to your appointment you can mosey on over to Understanding costs in advance.

DO I ALSO HAVE TO PAY FOR THE MEDICAL EXAMINATION, EVEN IF I DON’T NEED ANY VACCINATIONS?

This is America, so a doctor is never going to walk into the same room as you without sending a bill later, so yes, you will have to pay for the medical examination. The price varies depending on the civil surgeon. In New York it is typically around $250-$350 if you do not need any vaccinations but you can call around to different civil surgeons and ask to find lowest price in your area.

IS THERE AN EXEMPTION TO THE VACCINATION REQUIREMENT FOR PEOPLE WHO ARE SPECIAL LIKE ME?

Unfortunately, yes. USCIS will entertain requests for a waiver of the requirement but only under the following circumstances:

The religious or moral beliefs must be sincere.
You are opposed to all vaccinations in any form– a waiver may not be granted if you only object to specific vaccinations;
Your objection must be based on religious beliefs or moral convictions; and
The religious or moral beliefs must be sincere.

WHAT ABOUT COVID-19?

Under the immigration laws of the United States, a noncitizen who applies for an immigrant visa abroad, or who seeks to adjust status to that of a lawful permanent resident while in the United States (so any person who is seeking to become a resident), is required to receive vaccinations to prevent the following diseases:

• Mumps;
• Measles;
• Rubella;
• Polio;
• Tetanus and Diphtheria Toxoids;
• Pertussis;
• Haemophilus influenzae type B;
• Hepatitis B;
• COVID-19; and
• Any other vaccine-preventable diseases recommended by the Advisory Committee for Immunization Practices (ACIP).

You may want to consult a medical expert to confirm this, but my preliminary research has lead me to the conclusion that since COVID-19 is one of the diseases that an immigrant is required to receive vaccinations against, the COVID-19 vaccination would be necessary. The answer is yes. You need to get the COVID-19 vaccination if you would like to obtain residency in the US.

WHAT IF I ALREADY HAD COVID?

If you previously contracted COVID-19 and you make a sworn declaration in the presence of the Civil Surgeon who can confirm that you are not crossing any of your fingers or toes, then you will be exempt from the vaccination requirement³.