If you’re applying for a green card through adjustment of status, there’s been a major change to the process you need to know about. As of December 2, 2024, USCIS now requires you to submit Form I-693 — your immigration medical exam — with your initial I-485 application. If you don’t include it, USCIS can reject your entire application before anyone even reviews it.
What Changed?
For years, many immigration attorneys held off on the medical exam. The common strategy was to wait until USCIS issued a Request for Evidence or to bring the completed form to the adjustment of status interview. That approach no longer works.
USCIS made this change to cut down on the massive number of Requests for Evidence it was issuing for missing medical exams. Those requests created delays for applicants and extra work for the agency. Now, by requiring the I-693 up front, USCIS can review your case without unnecessary pauses.
The bottom line is simple. If your I-485 shows up without a properly completed I-693, USCIS can send it right back.
What You Need to Know About Form I-693
Form I-693 is the Report of Immigration Medical Examination and Vaccination Record. It proves that you don’t have any health conditions that would make you inadmissible to the United States on public health grounds.
Here’s what the process looks like. First, you need to find a USCIS-designated civil surgeon. This isn’t just any doctor — it has to be a physician specifically authorized by USCIS to conduct immigration medical exams. You can search for one in your area on the USCIS website.
At your appointment, the civil surgeon will conduct a medical examination and review your vaccination records. If you’re missing any required vaccinations, they can administer them during the visit. Once the exam is complete, the civil surgeon will hand you the finished I-693 in a sealed envelope. Do not open that envelope. If USCIS receives an unsealed or tampered envelope, they’ll send it back.
You then submit that sealed envelope with your I-485 application.
One Piece of Good News
As of January 2025, COVID-19 vaccination is no longer required for the immigration medical exam. USCIS waived this requirement entirely, and they will not issue any Requests for Evidence or denials based on missing COVID-19 vaccination documentation. That removes a significant hurdle that slowed down many applicants over the past few years. All other vaccination requirements — measles, mumps, rubella, polio, and others — still apply.
Don't Let a Missing Form Derail Your Application
The most important takeaway here is timing. Start the medical exam process early. Getting an appointment with a civil surgeon, completing any missing vaccinations, and receiving the finished form can take several weeks. If you wait too long, you risk delaying your entire green card application — or worse, having it rejected outright.
A missing I-693 is now one of the easiest ways to get your application sent back before it even gets reviewed. Don’t let that happen.
Need help with your green card application? Call the Law Office of Matthew Peterson at 617-391-0060.
