Quick Answer
Your I-693 medical exam, signed and sealed by a USCIS-designated civil surgeon, is now valid indefinitely once it is properly completed and submitted with your I-485 — but only if it is signed no more than 60 days before you file. Most denials and RFEs come from missing vaccinations, expired exams, broken seals, or a doctor who is not actually on the USCIS civil-surgeon list. In 2026 the safest pattern is: pick a real civil surgeon, do the exam after you file (or at the interview), and never open that envelope.
What Form I-693 Actually Is
Form I-693, Report of Immigration Medical Examination and Vaccination Record, is the medical clearance USCIS requires for almost every adjustment of status (I-485) applicant. It documents that you are not inadmissible on health-related grounds — meaning no Class A communicable disease, no harmful behavior tied to a physical or mental disorder, no drug abuse or addiction, and that you have the vaccinations USCIS requires.
It is not optional. With very narrow exceptions (some refugees, some asylees who already filed an I-693 with their asylum case), you cannot get a green card from inside the U.S. without one.
Who Can Sign It
Only a USCIS-designated civil surgeon can sign Form I-693. Your primary care doctor, urgent care, or a clinic that just sounds official does not count. If a non-civil-surgeon signs it, USCIS rejects the form, full stop.
You can find the official list on the USCIS website by ZIP code. Most cities have multiple options. Prices range from about $200 to $700 depending on location and how many vaccines you still need. Civil surgeons can charge what they want, and immigrant-heavy markets like Los Angeles, Houston, Miami, and the New York metro tend to be more expensive.
If you are abroad and going through consular processing rather than I-485, the rules are different — you see a panel physician designated by the U.S. embassy, not a civil surgeon, and the medical is handled directly by the embassy.
The 2026 Validity Rule (the part most people get wrong)
USCIS changed the I-693 validity rule and most of the older blog posts and YouTube videos online are flat wrong. Here is the current rule:
- The civil surgeon must sign the I-693 no more than 60 days before you file your I-485. If you file your I-485 first and the doctor signs later, that is fine.
- Once properly signed and submitted, the I-693 does not expire. It stays valid for the rest of that I-485 case, no matter how long USCIS takes.
This is a major change from the old "valid for two years" rule. It also means timing strategy matters: most attorneys now tell clients to file the I-485 first and bring the sealed I-693 to the interview, or to mail it after USCIS issues an interview notice. That avoids the risk of the medical going stale during a long backlog and avoids paying for the exam before you even know your I-485 will be accepted.
Vaccinations USCIS Requires in 2026
USCIS follows the CDC's Advisory Committee on Immunization Practices (ACIP) list, with some carve-outs. The current required vaccines for adults applying for adjustment include:
- Tdap or Td (tetanus, diphtheria, sometimes pertussis)
- MMR (measles, mumps, rubella)
- Polio
- Varicella (chickenpox) — unless you have documented immunity
- Influenza (seasonal, October–March)
- Pneumococcal (age-dependent)
- Hepatitis A and Hepatitis B
- Meningococcal (age-dependent)
- Rotavirus (children only)
- HPV (only when age-appropriate)
If you already had a vaccine years ago, bring written proof — vaccination cards from your home country, school records, prior U.S. doctor records. The civil surgeon can accept those instead of giving you the shot again.
If you cannot prove past doses, the doctor will either order a titer (blood test for immunity) or just give you the vaccine. Titers cost more but spare you injections you do not need.
Vaccine Waivers — When They Actually Work
USCIS allows three narrow vaccine waivers:
- Medical waiver. The civil surgeon documents that the vaccine is medically inappropriate for you (allergy, immune condition, age, pregnancy in some cases). The doctor checks the right box on I-693 and you are done — no separate filing.
- Not routinely available. The vaccine is not in stock or not in flu season. Civil surgeon notes this and you skip it.
- Religious or moral conviction waiver. This is the only one that requires a separate filing — Form I-601 with supporting evidence about your religious or moral objection. USCIS scrutinizes these and approval is not automatic. You need a coherent, sincerely held belief system that opposes vaccination, not a one-sentence "I do not believe in vaccines."
If you are filing I-601 for a vaccine waiver, do not do it alone. The denial rate is high when applicants try to wing the religious-belief explanation.
The Mistakes That Actually Delay I-485 Cases
1. Broken seal on the envelope
The civil surgeon will hand you a sealed manila envelope. Do not open it. If you open it, USCIS will not accept it — they will issue an RFE asking for a new signed and sealed I-693 from a civil surgeon. That is another exam, another co-pay, and 4–8 weeks of delay. We see this every month. Tape the envelope to your folder, do not get curious, do not "just check" the doctor's notes.
2. Doctor not on the USCIS list
People assume any doctor with "immigration physical" on a clinic website is USCIS-approved. That is wrong. Always cross-check the doctor's name on the USCIS civil-surgeon locator before paying. If they are not listed, the form will be rejected — and you will not get your money back from the clinic.
3. Filing the I-693 too early
If the civil surgeon signs the I-693 more than 60 days before you mail your I-485, USCIS will reject it as untimely under the current rule. The fix is simple: get the medical after you file or right before, not months in advance "to be ready."
4. Missing vaccinations with no waiver
If your I-693 shows missing required vaccines and the civil surgeon did not check a waiver box, USCIS issues an RFE. Always confirm with the doctor that every required vaccine has either been given, documented as previously received, or properly waived on the form before you accept the sealed envelope.
5. Outdated form edition
USCIS regularly updates Form I-693. If the civil surgeon uses an old edition, USCIS rejects the form. The current edition is on the USCIS website — print a fresh copy and bring it to your appointment if the doctor seems unsure.
6. TB skin test instead of IGRA blood test
USCIS now requires the IGRA blood test (Interferon Gamma Release Assay) for tuberculosis screening of applicants 2 years and older. The old TB skin test (PPD) is no longer acceptable as the initial screen. If your civil surgeon defaults to PPD, ask for IGRA — otherwise you will get an RFE.
7. Class A or Class B condition handled badly
If the doctor finds something — a positive TB result, a mental health note, a substance-use issue — that condition gets coded as Class A (inadmissible) or Class B (significant but not inadmissible). This is where you need your immigration attorney involved before the I-693 is finalized. There are paths to overcome most of these findings, but they require evidence — treatment records, follow-up testing, evaluations from a board-certified specialist — and you usually cannot fix it after the form is sealed.
When to Bring the Medical to the Interview
If you did not file the I-693 with the I-485 (the most common 2026 strategy), you bring the sealed envelope to your green card interview. Hand it to the officer at the start of the interview. Do not put it in checked luggage at the airport. Do not let your spouse "hold it." If it gets lost or opened, you have nothing.
For asylum-based adjustment, USCIS will sometimes accept the I-693 you filed with your asylum case if it was signed by a civil surgeon and complete. For most other categories, you need a fresh medical for the I-485.
Special Situations
Children
Children need an age-appropriate exam and the vaccinations on the CDC schedule. Civil surgeons skip vaccines that are not age-indicated yet. Bring the child's full vaccination history from the pediatrician.
Pregnancy
Live vaccines (MMR, varicella) are not given during pregnancy. The civil surgeon checks the medical-waiver box and notes the pregnancy. You can complete those vaccines after delivery if USCIS asks for an updated medical, but most cases are adjudicated on the original I-693.
Recent immigrants from high-TB countries
If your IGRA blood test is positive, you are not automatically inadmissible. The civil surgeon will refer you to the local public health department for further evaluation. You may need a chest X-ray and treatment records before USCIS clears the I-693. Build this time into your filing strategy.
Mental health history
USCIS only cares about mental health when there is a recent harmful behavior tied to a disorder. Old depression, anxiety, ADHD, etc., are not inadmissibility issues. Be honest with the civil surgeon, but do not over-disclose. If you have a complicated history, talk to your attorney before the appointment.
2026 Realistic Timeline
From the moment you decide to do the exam to USCIS having your I-693 in hand:
- Find a civil surgeon and book: 1–3 weeks
- Exam visit and blood work: same day, results in 5–10 days
- Vaccinations (if needed): same day or follow-up
- Sealed envelope ready for pickup: 1–2 weeks after the visit
- Submit at interview or by mail: depends on your case
If you are scheduling around an interview notice that gives you 30 days, start the day you receive the notice. Most civil surgeons can fit immigration medicals in within 2–3 weeks if you are flexible.
Cost Reality
Plan on a real budget — not the cheapest clinic ad on Facebook. Typical 2026 ranges:
- Civil surgeon visit: $200–$400
- IGRA blood test: $80–$200
- Each vaccine: $25–$200
- Titer (immunity blood test): $50–$150 per vaccine
A first-time applicant who needs most of the vaccine series can easily pay $500–$900 total. A well-vaccinated applicant who only needs the visit and IGRA is closer to $300–$450. Some county health departments offer discounted vaccines, which can shave several hundred dollars off — call before you go.
What to Bring to the Civil-Surgeon Appointment
- Government-issued photo ID (passport is best)
- All vaccination records you have (any country, any year)
- Records of any chronic conditions, mental health treatment, or substance-use treatment
- List of current medications
- Any prior chest X-ray or TB test results
- Form I-693 (some surgeons supply it; bring your own copy of the latest edition just in case)
- Payment in the form the office accepts
If USCIS Issues an RFE on Your I-693
Common RFEs:
- "Submit a properly completed and signed Form I-693" — usually a missing signature, missing seal, or wrong form edition.
- "Submit evidence of [vaccine]" — the surgeon failed to check the right box; either give that vaccine and submit an updated I-693 page, or get a corrected form.
- "Submit medical follow-up for Class B finding" — get the specialist evaluation USCIS wants and have the civil surgeon update the I-693.
Do not panic on RFEs. They have deadlines (usually 87 days). The fix is almost always another visit to the civil surgeon and a new sealed envelope.
What Modern Law Group Does on Medical Exams
For our adjustment-of-status clients we:
- Pick the right civil surgeon for your ZIP code and case profile
- Prep your vaccination history before the visit so you do not get extra shots
- Handle Class A or Class B findings before the form is sealed
- Decide whether to file the medical with the I-485 or hold it for the interview
- Respond to RFEs without restarting the medical when we can avoid it
If you are at the I-485 stage and not sure when or where to do your medical, that one-hour conversation with an immigration attorney is worth more than your civil-surgeon fee.
Talk to a Real Immigration Attorney
The medical exam is not the hardest part of your case, but it is the easiest part to break. Get it right the first time. Modern Law Group has filed thousands of I-485s with a 99%+ approval rate — call (888) 902-9285 or use the chat widget on this page to get a free case evaluation.