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 all spouses seeking a marriage-based green card. The exam, to be completed by a government-authorized doctor, consists of several parts:

  • A review of your medical history and immunization records
  • A physical and mental evaluation
  • Drug and alcohol screening
  • Tests for various diseases and illnesses

The purpose of the green card medical exam is to ensure that the spouse 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! Adequate preparation can make the entire exam less stressful and also help you avoid any issues that could delay or cause 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: before, during, and after.

For the flat rate of $750, Boundless helps you complete your entire marriage-based green card (spousal visa) application, including all required forms and supporting documents, independent attorney review, and support from the moment your application is filed until you receive your green card. Learn more about our services, or get started today.


Before the Exam


Who’s the 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:

  • If you’re applying from within the United States, you will see a civil surgeon designated by U.S. Citizenship and Immigration Services (USCIS).
  • If you’re applying from abroad, you will see a panel physician authorized by the U.S. Department of State.

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 exam cost?

You can typically expect to pay about $200 for the medical exam, but the exact price varies significantly by doctor. (Boundless also has a detailed guide on all the costs of a marriage-based green card.)


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 spouse seeking a green card is applying from. Regardless, the exam must be completed prior to your green card interview, so it’s important to be mindful of the marriage green card timeline for your particular situation.

If you’re applying from within the United States

When to schedule: You have two options — each with pros and cons — as far as when to schedule your appointment (also see this important policy change from USCIS regarding when the results must be certified by a doctor and how long they will be valid):

1. Schedule it 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.” You are not required to do it this way. With this option, however, you risk needing to repeat the medical exam (and pay the doctor’s fees again) if USCIS does not schedule your green card interview before your initial exam results expire. (See below about an important policy change from USCIS regarding when the results must be certified by a doctor and how long they will be valid.)

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 (Form I-485) or bring the results with you to your green card interview. Some people choose this option to avoid needing to take the medical exam a second time — as long as USCIS schedules their interview within two years (the exam results expire after that, as of November 1, 2018). But if they wait too long — and it’s hard to predict when USCIS will schedule the interview — then they also risk not completing the medical exam in time. (See below about an important policy change from USCIS regarding when the results must be certified by a doctor and how long they will be valid.)

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.


IMPORTANT: USCIS recently announced an important change to the rules regarding medical exams conducted in the United States (effective November 1, 2018):

  • The medical exam results form, I-693 (more information about this form below), must be signed by a civil surgeon no earlier than 60 days before the green card application (Form I-485) is submitted. For example, if you submit your application package on February 1, 2019, the earliest that a civil surgeon may sign your Form I-693 would be December 3, 2018 (60 days before). (If the doctor signed the form more than 60 days before you submitted your green card application — following the same example, that would be December 2, 2018 or earlier — the results will be invalid, and you will need to repeat the medical exam.)
  • Exam results will be valid for two years instead of one year.

If Form I-693 was signed before November 1, 2018, the results will also be valid for two years except in the following cases:

  • If the doctor signed Form I-693 more than 60 days before you submitted your green card application to USCIS — and you submitted Form I-693 within one year after the doctor signed it — then the results will be valid for only one year from the date you submitted  Form I-693. For example, let’s say the doctor signed Form I-693 on December 2, 2018, and you submitted your green card application on February 1, 2019 (61 days later). You hold on to Form I-693 and don’t submit it to USCIS until November 2, 2019 (11 months after the doctor signed it). In this case, your medical exam results will be valid until November 2, 2020 (one year after you submitted Form I-693).
  • If you submit Form I-693 to USCIS more than one year after the doctor signed it, the results will be invalid, and you will need to repeat the exam. For example, if the doctor signed Form I-693 on October 31, 2018, and you submit it to USCIS on November 1, 2019 (one year and one day later), USCIS will reject the results, and you will need to repeat the medical exam.

If you’re applying for a green card from abroad

When to schedule: You may schedule your medical exam only once 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 spouses living abroad. The State Department explicitly instructs spouses 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, which is often just weeks after the NVC sends the appointment letter.

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 spouse 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.


IMPORTANT: See above for information about a recent important change that USCIS made to the rules regarding medical exam results.


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.

Boundless turns all the required government forms for a marriage-based green card into simple questions you can answer online — typically in under two hours, compared with days or weeks the traditional way. We make it easy to complete your green card application and avoid common problems. Learn more about what Boundless does, or get started now.


During the 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.)

During the medical exam, 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.


IMPORTANT: As of October 1, 2018, the IGRA is the only acceptable tuberculosis test for all green card applicants within the United States. Civil surgeons may no longer use the tuberculin skin test (TST) as an alternative option to the IGRA. The civil surgeon performing this test will most likely be aware of the CDC’s updated guidance, but it’s nonetheless important to make sure that you receive the right kind of tuberculosis test.

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.


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).

Boundless helps you prepare for every milestone of the marriage-based green card process, including the medical exam. Find out more about what you get with Boundless, or let’s begin!


After the Exam


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.

Boundless stays with you until the green card finish line — helping you respond to government questions and prepare for your green card interview. Learn more about our services, or start your application today.


Important Information 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 spouse 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 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.

Recently, however, the U.S. Department of Homeland Security (DHS) proposed changes to the “Public Charge” rule that could potentially expand the scope of the medical exam and tighten the standards for scrutinizing green card, visa, and U.S. citizenship applicants with medical conditions (see our blog post to learn more about these plans).

With Boundless, you get the peace of mind that comes with having an independent immigration attorney who answers your confidential questions and reviews your entire green card application. Read more about what we do, or get started now.


Preventing or Challenging Health-Related Denial


A spouse 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 spouse 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 marriage-based green card application? With Boundless, you get an independent immigration attorney who will answer your questions and review all of your application materials — for no additional fee. Ready to start?



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