Immigration medical exam (Form I-693) and required vaccinations

Immigration medical exam (Form I-693) and required vaccinations

Most green card applicants and certain other immigration applicants must complete a medical exam (Form I-693) with a USCIS-designated civil surgeon. The exam includes a physical, mental health screening, communicable-disease screening (TB, syphilis, gonorrhea), and proof of required vaccinations.

This cluster explains every vaccine USCIS currently requires, where to get them affordably, how to use blood tests (titers) when records are missing, and the exemption process.

Who needs the medical exam

• Adjustment of status (I-485) — green card from inside US
• Refugee or asylum applicants — within 1 year of arrival or status grant
• Visa Waiver Program — NOT required
• Consular processing — use panel physician abroad, NOT civil surgeon
• DACA renewal — NOT required (DACA is not adjustment of status)
• TPS — NOT required for TPS itself

Required vaccines (11 total)

USCIS requires the following per CDC Civil Surgeon Technical Instructions (updated March 2025):

• MMR (Measles, Mumps, Rubella) — Measles, mumps, rubella
• Tdap / DTaP (Tetanus, Diphtheria, Pertussis) — Tetanus, diphtheria, pertussis (whooping cough)
• Polio (IPV) — Poliomyelitis (polio)
• Influenza (Flu) — Seasonal influenza
• Varicella (Chickenpox) — Varicella zoster (chickenpox)
• Hepatitis A — Hepatitis A virus
• Hepatitis B — Hepatitis B virus
• Meningococcal (MenACWY) — Meningococcal disease (meningitis)
• Pneumococcal — Streptococcus pneumoniae (pneumonia, meningitis, bloodstream infections)
• Hib (Haemophilus influenzae type b) — Haemophilus influenzae type b (bacterial meningitis, epiglottitis)
• Rotavirus — Rotavirus gastroenteritis (severe diarrhea in infants)

Important policy notes (2025–2026)

• COVID-19 vaccine is NO LONGER required. The COVID-19 requirement was added in October 2021 and rescinded January 22, 2025. Civil surgeons cannot require it for I-693.
• No vaccine “catch-up” required for very expensive series if you are missing only 1–2 doses of a multi-dose series and would face severe hardship; consult your civil surgeon about medical waivers.
• Pregnant women receive deferrals on live vaccines (MMR, varicella) and must complete after delivery.
• People born before 1957 are presumed naturally immune to measles, mumps, rubella — MMR not required with proof of birth year.

Supporting topics

• Where to get immigration vaccinations — free and low-cost options
• Vaccine costs with and without insurance
• Vaccine exemptions and waivers — medical, religious, moral
• Vaccines for Children (VFC) program — free vaccines for kids

Civil surgeon vs panel physician

Find a civil surgeon: USCIS Find a Doctor tool. Cost of the full I-693 exam typically $200–$500 depending on city and which vaccines you need. Vaccines are charged ON TOP of the exam fee.

Bringing your medical exam to USCIS

• Civil surgeon will seal the I-693 in an envelope
• DO NOT OPEN THE ENVELOPE — USCIS will reject an opened I-693
• Submit with I-485 application or bring to your interview
• Valid for 2 years from the date the civil surgeon signs

Related procedures

• I-485 Adjustment of Status
• Marriage to US citizen — adjustment of status
• Find immigration attorney
• USCIS notice codes
• Community health centers by state — low-cost vaccine providers

Last verified: 2026-05-25. CDC Civil Surgeon Technical Instructions updated March 11, 2025.

General procedural and health information. Not medical or legal advice. Consult your physician for medical decisions and a licensed immigration attorney for case-specific guidance.

Related procedural information

• Consulate of your country in the US — passport renewal, consular ID, document apostille
• ITIN — file federal taxes without SSN — required regardless of immigration status
• USCIS form library — federal immigration forms (I-130, I-485, N-400, etc.)
• Find an immigration attorney — pro bono lists + AILA + BIA-recognized
• Know Your Rights — ICE encounters — constitutional protections