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The Immigration Medical Exam, Explained

What to expect and how to prepare for the green card medical exam

The green card medical examination is an important step of the immigration process and is required for most green card applicants. The exam must be completed by a government-authorized doctor (also known as a civil surgeon). In the immigration medical exam, you can expect:

  • A review of your medical history and immunization (vaccine) records
  • A physical and mental evaluation
  • Drug and alcohol screening
  • Tests for various diseases and illnesses (sometimes including an X-ray)

The purpose of the green card medical exam is to ensure that the relative seeking a green card has no health condition that could make them “inadmissible” to the United States — meaning they’re ineligible to receive a green card.

Many green card applicants get nervous about this step of the process, and that’s normal. But there’s no need to worry! Boundless can help you avoid common pitfalls in the immigration process with unlimited support from our team of immigration experts. Learn more.

Adequate preparation can make the entire exam less stressful and also help you avoid any issues that could delay or cause the denial of your green card application. Plus, it’s rare to fail the medical exam. And even if you do have a condition that might complicate your green card application, you can often request a waiver.

To help you prepare, this guide will cover everything you can expect in every stage of the medical exam process.


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Choosing the Right Doctor

There are only two types of doctors who can perform the medical exam, and the right one for your situation depends on where you’re applying from:

Important:

When choosing a doctor, make sure to ask about fees, the doctor’s availability, and whether they accept your health insurance.


How Much Will the Medical Exam Cost?

The cost of the medical exam varies significantly by location and provider. Boundless customers have reported paying between $100 and $500, but $200 is typical. Unfortunately, there is no government funding for the immigration medical exam, so you’ll have to pay this cost yourself.

Boundless can help you avoid common pitfalls in the immigration process with unlimited support from our team of immigration experts. Learn more.


When and How Do I Schedule the Exam?

The process for scheduling the medical exam and the validity period of the results depend on where the family member seeking a green card is applying from.

If you’re applying from within the United States

When to schedule: You have two options as far as when to schedule your appointment:

  • Option 1 (Recommended): Complete the medical exam and submit the unopened exam report at the same time as the green card application.
  • Option 2: Schedule the medical exam after submitting the green card application and bring the exam report to the green card interview.

USCIS recommends option 1 to save time and lower your risk of receiving a Request a Evidence (RFE).

Below we’ll explain both options in more detail.

Option 1: Schedule your medical exam before you begin the green card application process. In this case, you would submit your medical exam results with your application package (including all government forms and supporting documents). This process is known as “concurrent filing.”

IMPORTANT: The medical results form is valid for two years. As of March 31, 2023, applicants can submit their medical exam form up to two years from when the civil surgeon signed it. Previously, USCIS had to receive the medical results no later than 60 days after the physician signed it.

Option 2: Schedule it after filing your green card application package. In this case, you can either send your medical exam results to USCIS soon after submitting your green card application (using Form I-485) or bring the results with you to your green card interview. If choosing this option, the results are valid for two years from when the doctor signed the form. In both cases, USCIS requires that the report be unopened and in the sealed envelope provided by the doctor.

Again, USCIS recommends option 1 to speed up the process and lower the risk of an RFE.

How to schedule: Use the USCIS “find a doctor” tool, or call the USCIS Contact Center at 1-800-375-5283 (TTY: 1-800-767-1833) to locate a nearby civil surgeon authorized to perform immigration medical exams. Let the doctor’s office know that you are contacting them to set up a medical exam appointment for immigration purposes.

If you’re applying for a green card from abroad

When to schedule: You may schedule your medical exam only after you’ve received your green card interview appointment letter from the National Visa Center (NVC), which is part of the State Department that processes green card applications for relatives living abroad. The State Department explicitly instructs family members seeking a green card from abroad not to schedule their medical exam until they’re notified of their green card interview date.

How to schedule: Far in advance of receiving your appointment letter, search for your U.S. embassy or consulate, which provides instructions for the medical exam, as well as contact information on authorized doctors in each country. You will need to select a doctor yourself (the NVC will not assign one to you). It’s generally best to set up your appointment as soon as you receive an interview appointment date from the NVC.

When you schedule your appointment, make sure to let the doctor’s office know that you seek a medical exam to immigrate to the United States.

The exam results will be valid for six months (unless the relative seeking a green card has certain medical conditions, in which case the exam results could expire in three months).


What Should I Bring to My Exam?

Having all of your documents ready before your appointment can help the medical exam go smoothly. Here’s what you’ll need to bring with you:

  • Your immunization or vaccination records
  • A copy of your medical history
  • Copies of any previous chest X-rays, if any
  • A letter from your regular doctor outlining the treatment plan for any health problems you have
  • A government-issued photo ID, such as your passport, state ID, driver’s license, travel permit, or work permit
  • Payment for the medical exam fee (check with the doctor’s office before your appointment for acceptable payment options)
  • Your health insurance card, if any (check with the doctor’s office before your appointment if they accept your insurance)

You must also bring an additional document, depending on where you’re applying from:

If you’re applying from within the United States

You must also bring Form I-693 (officially called the “Report of Medical Examination and Vaccination Record”), which is where the civil surgeon will document the results of your exam.

Most doctors will provide a copy of this form at their office. Generally, however, it’s best to download Form I-693 from the USCIS website yourself (to make sure you’re using the latest version) and bring it with you to the doctor’s office. USCIS periodically updates these forms, and some doctors forget to replace old copies with current ones. If you submit an expired form, USCIS will reject it and ask you to submit the newest edition of the form, which means returning to the doctor’s office and delaying the application process.

To save time, it’s a good idea to complete your portion of the form before going to your appointment, but do not sign the form until the civil surgeon instructs you to do so. The civil surgeon will complete their portion of the form at the end of your exam.

There is no fee to file Form I-693, but you will need to pay the medical exam fee (see above).

If you’re applying from abroad

You must bring your green card interview appointment letter from the NVC. The doctor will not perform the medical exam unless you arrive with this document, which they’ll use to verify that you have an active green card application.

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During the Green Card Medical Exam

The green card medical exam is not like a routine physical you’d receive from your family doctor. Nor will the doctor give you a “pass” or “fail” grade based on your overall health. (See below for important medical exam information for women.)

The exam will last roughly two hours, and during that time, the doctor will review your immunization and medical history with you. They will ask both general and specific questions about your health. You’ll also get a basic checkup (or “physical”).

In addition, the doctor will look for specific conditions that fall into the following categories (see below for information about how the presence of such conditions can affect your green card application):

  • Communicable diseases (including tuberculosis, syphilis, and gonorrhea)
  • Drug abuse or addiction
  • Physical or mental disorders associated with harmful behavior
  • Conditions that make it impossible for you to support yourself

To check for the above conditions, the doctor will conduct several types of tests:

Tuberculosis test

Civil surgeons in the United States and panel physicians abroad follow different tuberculosis testing guidelines from the Centers for Disease Control and Prevention (CDC):

If you’re applying from within the United States

The civil surgeon will follow the CDC’s Tuberculosis Technical Instructions for Civil Surgeons, which currently require them to conduct a test called the “interferon gamma release assay” (IGRA) on all green card applicants aged 2 and older. Generally, you will not be required to return to the doctor’s office to obtain the IGRA results.

If, however, the IGRA results reveal signs or symptoms of tuberculosis, you’ll be required to return to the clinic in order to get a chest X-ray and undergo other further testing.

If you’re applying from abroad

The panel physician will follow the CDC’s Tuberculosis Technical Instructions for Panel Physicians, which currently require all green card applicants aged 15 and older (in countries considered to be “heavily tuberculosis-burdened”) to have a chest X-ray.

If necessary, you may be required to return to the clinic for further testing if the chest X-ray and other relevant screening (medical history review and physical checkup) show signs and symptoms of tuberculosis.

It’s important to also check the specific medical exam instructions from your U.S. embassy or consulate that may be relevant to tuberculosis testing.

Blood and urine tests

Doctors are required to perform a blood test for syphilis and a urine test for gonorrhea on all green card applicants aged 15 and older — whether applying from within the United States or abroad.

Vaccination screening

The doctor is required to make sure that you’ve received all required vaccines. If you’re missing any, you’ll be required to obtain these before you attend your green card interview, but the doctor should be able to provide these vaccines during your medical exam.

Important:

USCIS now requires green card applicants to show proof of vaccination against COVID-19 when attending the medical exam. Learn more about the COVID-19 vaccine requirements when immigrating.

Drug and alcohol screening

The doctor will ask questions about any prescription drugs you take, as well as your past and present drug and alcohol use.

To learn more about specific screening procedures for green card applicants, check out the CDC’s guidance for civil surgeons (if you’re applying from within the United States) or its guidance for panel physicians (if you’re applying from abroad).

Let Boundless be your immigration go-to, we’ll help you prepare for every milestone in the green card process, including the medical exam. Learn more about what Boundless can do to help.


After the Green Card Medical Exam

The civil surgeon will ask you to sign the form once the exam is complete. Do not forget to sign the form — USCIS will not accept unsigned forms. Unless you’re instructed to come back to the doctor’s office, the doctor will provide your medical exam results in a sealed envelope at the end of your appointment. Do not break the seal or open the envelope.

Doctors normally provide a copy of the results for your records. This is the only copy you are allowed to open. If they don’t automatically give you a copy, it’s generally a good idea to ask for one before they seal the envelope.

If you’re applying from within the United States

You must send the sealed, unopened envelope (which also contains your completed Form I-693) to USCIS or bring it to your interview, depending, again, on whether you schedule your medical exam before or after filing your green card application package (see scheduling instructions above).

If you’re applying from abroad

The doctor will either give you the sealed, unopened envelope (and your X-ray) to bring to your interview, or they may send it directly to your U.S. embassy or consulate, depending on your home country’s specific requirements for the medical exam.


Important Information About the Immigration Medical Exam for Women

All female applicants must complete the medical exam even if they are having a menstrual period.

In addition, women who are pregnant must have a chest X-ray, if required. They must, however, give prior consent to the doctor and must be provided additional protection during the procedure.

Pregnant women may also postpone the X-ray until after giving birth, but the X-ray must be completed before entering the United States (if applying from abroad) or before completing a green card application, or Form I-485 (if applying from within the United States).


Health-Related Reasons for Denial

During the exam, the doctor’s job is to make sure that the relative seeking a green card doesn’t pose a health threat to current residents of the United States.

The main health-related reasons why a person might be denied a green card include the following:

Communicable diseases: If you have active, untreated, and infectious gonorrhea, leprosy, syphilis, or tuberculosis, you will be unable to get a green card until the disease has been treated and/or cured.

Drug and alcohol abuse: If you have a history of drug abuse, you might be asked to take a drug test and/or certify that you have completed a drug treatment program. If you’re currently abusing prescription drugs, illegal drugs, or alcohol, you will not be allowed to get a green card.

Mental illness with a history or threat of violence: If you have a mental illness that has caused you to be violent in the past or is associated with violence, either against yourself or others, you may have trouble getting a green card. According to USCIS policy, drunk driving falls into this category.

Inability to work: If your health is so poor that you won’t be able to support yourself financially, you could be denied a green card based on your likelihood of becoming a “public charge,” basically a person who has depended, or is likely to depend at any time in the future, on government benefits. This is likely the case for people with serious degenerative or fatal diseases.


Preventing or Challenging Health-Related Denial

A relative seeking a green card generally would not be denied on medical grounds if they:

  • Have a cold at the time of the medical exam.
  • Have a chronic but well-managed disease, such as diabetes or heart disease.
  • Are HIV-positive.
  • Previously had one of the communicable diseases listed above (and have since been cured).

If, however, a relative seeking a green card has a health-related condition that could lead to denial of their application, it’s generally best to do the following:

If you’ve tested positive for gonorrhea, syphilis, leprosy, or tuberculosis in the past: It’s important to show USCIS or the State Department that you have been successfully treated. Typically, the best way to do so is to bring copies of your medical records showing the treatment you received and the results of that treatment, as well as a statement from your regular doctor confirming that your disease is either cured or being managed.

If you have any history of drug abuse or mental illness: It’s important to bring proof to the medical exam that your drug addiction has been treated or that your mental health is under control.

If you have any other potentially serious disease: It’s good practice to get a letter from your regular doctor explaining how your disease is controlled and how your life is affected — including how your illness impacts your ability to work, if at all.

If your green card application is denied for health-related reasons: You can apply for a “waiver of inadmissibility” (basically, “forgiveness” from the U.S. government in order to enter the United States).

USCIS will generally consult with the CDC to determine if a waiver should be granted. USCIS can also attach conditions to the grant of a waiver as they see fit. For example, an applicant with tuberculosis would need to agree to see a doctor immediately upon entering the United States and make arrangements to receive treatment. USCIS may deny a waiver if the applicant openly states that they’re unwilling to obtain treatment for their medical condition.

Do you have confidential questions about how a medical condition might affect your green card application? Boundless has helped more than 100,000 people with their immigration plans, we can help you too. Get started today!


Immigration Medical Exam FAQs

The Immigration Medical Exam is a medical examination required by U.S. Citizenship and Immigration Services (USCIS) for certain immigrants who are applying for a green card or other immigration benefits. The exam is conducted by a USCIS-approved civil surgeon and is used to determine whether an immigrant is inadmissible to the United States on health-related grounds.

Applicants for permanent residency (green card holders) are generally required to take the Immigration Medical Exam. However, there are some exceptions, such as applicants who are under the age of 14 or over the age of 79, applicants who have already been granted permanent residency, or applicants who have a waiver from USCIS.

USCIS has a list of approved civil surgeons on its website. You can also contact your local USCIS office for more information.

The medical exam involves a physical examination, as well as blood and urine tests. The civil surgeon will also review your immunization records and may administer vaccinations if you are not up-to-date on your shots.

Yes, you will need to bring your passport or other photo ID, as well as your immunization records (if you have them). You should also bring any medications that you are currently taking, as well as any documentation from your doctor regarding any medical conditions that you have.

The length of the exam depends on how many people are being seen at the same time, but it typically takes between 30 minutes to two hours.

If you are found inadmissible and you believe that there was an error made during your green card medical examination, you can file an appeal with USCIS within 30 days of receiving your notice of inadmissibility