TLDR: If you’re applying for a U.S. green card through adjustment of status in 2026, you must submit Form I-693 (your immigration medical exam) at the same time as your Form I-485 application, not later. Your exam must be completed by a USCIS-designated civil surgeon, and the form must arrive at USCIS in a sealed envelope. COVID-19 vaccination is no longer required, but standard vaccinations (MMR, polio, hepatitis A and B, Tdap, varicella, influenza, and others) still are. Importantly, an I-693 is now tied to a single application; if your case is denied or withdrawn, you’ll need a brand-new exam for any future filing. Plan ahead: scheduling, vaccinations, and follow-up testing can take several weeks.
If you’ve started preparing your green card application, you’ve probably noticed the immigration medical exam sitting on your checklist. It’s one of those steps that sounds straightforward (go to a doctor, get a form signed) but the rules around it have changed significantly over the past two years. Submitting it incorrectly, or at the wrong time, is now one of the most common reasons applications get rejected before USCIS even reviews them.
Here’s what you need to know about Form I-693 in 2026, why timing matters more than ever, and how to avoid the missteps that delay or derail green card cases.
What Is Form I-693, and Who Needs It?
Form I-693, officially called the Report of Immigration Medical Examination and Vaccination Record, is the form a USCIS-designated civil surgeon completes after examining you. Its purpose is narrow: it confirms you don’t have a medical condition that would make you inadmissible to the United States on public health grounds.
Most applicants filing Form I-485 (Application to Register Permanent Residence or Adjust Status) need to submit a completed I-693. This includes family-based, employment-based, and most other adjustment categories. A few groups have modified requirements, for example, K-1 fiancé(e) visa holders and certain refugees or asylees who already had an overseas exam may only need to complete the vaccination portion.
What the Exam Actually Checks
The civil surgeon is looking at a defined list of items, not your overall health. Specifically, the exam screens for:
- Communicable diseases of public health significance, including tuberculosis, syphilis, and gonorrhea
- Required vaccinations appropriate for your age
- Physical or mental disorders associated with harmful behavior
- Drug abuse or addiction
A diagnosis alone of past TB exposure, a mental health history, or prior treatment for substance use does not automatically make you inadmissible. What matters is accurate documentation and proper classification by the civil surgeon.
The Big Rule Change: Submit the Exam With Your Application
For years, many applicants and attorneys waited to submit the I-693, bringing it to the green card interview, or sending it later in response to a Request for Evidence. That approach no longer works.
As of December 2, 2024, USCIS requires Form I-693 (or, in limited cases, a partial I-693 with just the vaccination record) to be submitted at the same time as your Form I-485. If it’s missing, USCIS can reject the entire application package before any officer reviews your case.
The agency made this change to reduce the backlog of Requests for Evidence and speed up adjudications. The practical effect for applicants: your medical exam needs to be done early enough to file with everything else, but recent enough that it remains valid through adjudication.
One Application, One Exam
In June 2025, USCIS clarified another important rule. A Form I-693 signed on or after November 1, 2023 is only valid for the specific application it was submitted with. If your I-485 is denied or withdrawn, that medical exam can’t be reused. Any future filing requires a brand-new exam.
This is a meaningful shift from the prior policy, which had treated post-November 2023 exams as valid indefinitely. If you’re refiling after a denial, build the cost and time of a new exam into your plan.
Vaccination Requirements in 2026
Required vaccines are based on CDC’s Advisory Committee on Immunization Practices schedules and depend on your age. The list typically includes MMR, varicella, hepatitis A and B, Tdap, polio, seasonal influenza, meningococcal (where age-appropriate), and pneumococcal vaccines.
A notable update: as of January 2025, COVID-19 vaccination is no longer required for the immigration medical exam. USCIS will not issue Requests for Evidence or denials based on missing COVID-19 documentation.
Bring Your Records
If you have written documentation of past vaccinations (childhood immunization records, school forms, prior medical charts) bring everything to your appointment. Self-reported vaccine history without documentation isn’t accepted, but valid records can save you from repeating doses and paying for them again. If records are missing, the civil surgeon can order titer tests to confirm immunity, or administer catch-up vaccines on the spot.
Practical Tips to Avoid Delays
A few habits separate smooth filings from frustrating ones:
- Use a USCIS-designated civil surgeon. Your regular doctor cannot complete this form unless they’re on the official list. You can search the USCIS website to find one near you.
- Don’t open the sealed envelope. The civil surgeon will hand you Form I-693 in an envelope sealed across the flap. If you’re filing by mail, submit it sealed. If you’re filing online, you’ll open it only to upload the contents, but USCIS may later ask to see the original.
- Check the form before you leave. Confirm your name, date of birth, and A-number (if you have one) are correct. Small clerical errors are far easier to fix the same day.
- Start early. Between appointment availability, vaccine series that require multiple doses, and lab work for TB or syphilis testing, the full process can take several weeks.
Be Prepared For Your Green Card Medical Exam
The 2026 medical exam isn’t complicated, but the timing and procedural rules are stricter than they used to be. Filing with a complete, properly sealed I-693 the first time is the cleanest path to keeping your green card case on track.
If you’re navigating adjustment of status, whether through family, employment, or another category, Berardi Immigration Law can help you map out the timing, coordinate with civil surgeons, and make sure every piece of your application package meets USCIS requirements before it leaves your hands.
Frequently Asked Questions
Q: Can I use my regular family doctor for the immigration medical exam?
Only if your doctor is a USCIS-designated civil surgeon. The vast majority of physicians are not. You can find a designated civil surgeon through the USCIS website or by calling the USCIS Contact Center.
Q: How much does the medical exam cost in 2026?
Costs typically range from about $200 to $500, depending on location and the civil surgeon’s fees. Missing vaccines, additional lab work, or follow-up testing can add to the total. Most health insurance plans do not cover immigration medical exams, so plan to pay out of pocket.
Q: What happens if the civil surgeon finds a medical issue?
A finding doesn’t automatically deny your application. For some conditions, you may be asked to provide additional documentation or apply for a waiver of inadmissibility. Most issues that come up are manageable, especially when handled with proper records and an experienced civil surgeon.
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