What is Form I-693?
Form I-693, Report of Immigration Medical Examination and Vaccination Record, is a USCIS form used to document the results of a mandatory medical examination for individuals applying for adjustment of status (Green Card applicants). The medical examination helps USCIS determine whether an applicant is inadmissible on health-related grounds, as per Section 212(a)(1) of the Immigration and Nationality Act (INA).
Who Can Fill Out and Sign Form I-693?
- The Applicant (Green Card Applicant)
- Completes Part 1 of the form with personal details.
- Signs in the presence of the USCIS-designated civil surgeon.
- The Civil Surgeon (Designated Doctor)
- Completes the rest of the form after performing the medical exam.
- Signs and certifies the form before sealing it in an envelope for USCIS submission.
Who Can Conduct the Medical Examination?
✔ Only a Civil Surgeon designated by USCIS can perform the exam in the U.S.
✔ To find a designated civil surgeon, use the USCIS “Find a Doctor” tool https://www.uscis.gov/tools/find-a-civil-surgeon
✔ Military physicians or designated public health department doctors may also conduct exams in specific cases.
Medical Tests Required for Form I-693
The medical exam includes tests for:
1. Communicable Diseases of Public Health Significance
- Tuberculosis (TB) test
- Ages 2 and above: Must undergo an initial TB screening (IGRA blood test).
- If positive, a chest X-ray is required.
- If TB is diagnosed, the applicant must complete treatment before USCIS approval.
- Syphilis and Gonorrhea tests
- Ages 15 and older: Must be tested for syphilis (blood test) and gonorrhea (urine test).
- Other STDs and Hansen’s Disease (Leprosy)
- The civil surgeon may evaluate for other infections if suspected.
2. Drug Abuse Screening
- Current drug addiction or abuse leads to inadmissibility.
- Past drug abuse may require a waiver.
3. Mental Health Disorders with Harmful Behavior
- A history of self-harm, violence, or psychiatric conditions may require further evaluation.
Vaccinations Required for Form I-693
The civil surgeon will review the applicant’s vaccination history and ensure compliance with CDC guidelines. Required vaccines include:
1. Standard Vaccines
✔ MMR (Measles, Mumps, Rubella)
✔ Polio
✔ Hepatitis A & B
✔ Varicella (Chickenpox)
✔ Tdap (Tetanus, Diphtheria, Pertussis)
✔ Influenza (Seasonal Flu Vaccine, if available)
2. COVID-19 Vaccine (Latest USCIS Policy)
✔ USCIS requires full COVID-19 vaccination (all doses must be completed) unless exempt.
✔ Blanket waivers are available if the vaccine is not routinely available in the applicant’s location.
Who is Exempt from Certain Medical Tests or Vaccinations?
1. Age-Based Exemptions
- Children & Elderly: Some vaccines are not required for individuals outside the CDC-recommended age range.
- End of this blog age based exemption is discussed in more detail
2. Medical Exemptions
- Allergies or adverse reactions to vaccines.
- Pregnancy may exempt applicants from certain vaccines.
- Immune conditions (such as cancer treatment) may require medical waivers.
3. Religious or Moral Exemptions
- Applicants can request a waiver for vaccinations based on sincerely held religious beliefs or moral convictions. End of this blog religious exemption is discussed in more detail
- To apply:
- Submit Form I-601 (Waiver of Grounds of Inadmissibility).
- Provide detailed evidence (affidavits, religious statements).
- USCIS has discretion to approve or deny the waiver.
Finding a Civil Surgeon & Completing the Medical Exam
✔ Use the USCIS “Find a Doctor” tool to locate a designated civil surgeon.
✔ Bring government-issued ID, vaccination records, and prior medical history.
✔ After the exam, the civil surgeon will seal Form I-693 in an envelope (only USCIS can open it).
✔ You may request a copy for personal records before the envelope is sealed.
Cost of the Medical Exam & Insurance Coverage
✔ Medical Exam Fees: Typically $200 – $500 (varies by location).
✔ Vaccine Costs: $50 – $250 per shot (depends on insurance and clinic).
✔ Insurance Coverage:
- Some private health insurance plans may cover vaccines.
- Medicaid may cover costs in some states.
- Many USCIS-approved doctors do not accept insurance, requiring out-of-pocket payments.
How Long Does It Take to Complete All Medical Requirements?
✔ If missing vaccinations: 1-4 weeks (depending on required doses).
✔ TB test and results: Typically 3-7 days.
✔ Blood tests (syphilis, gonorrhea): Results in a few days.
What Happens If TB Test is Positive?
✔ Step 1: IGRA blood test → If positive, a chest X-ray is required.
✔ Step 2: If the X-ray suggests TB, a sputum test and treatment plan are required.
✔ Step 3: If treatment is needed, USCIS may delay Green Card processing until the treatment is completed.
Common USCIS Requests for Evidence (RFEs) Related to Form I-693
🔹 Expired Form I-693: Medicals are valid for 2 years from the civil surgeon’s signature date.
🔹 Missing vaccinations: If an applicant fails to provide proof or the civil surgeon doesn’t check all required boxes.
🔹 Incomplete TB or STI tests: If additional testing is needed, USCIS may issue an RFE to redo certain tests.
How to Avoid RFEs for Form I-693
✔ Submit the most recent version of Form I-693.
✔ Ensure all required vaccinations are completed before submitting the form.
✔ Verify that the civil surgeon seals the form properly before submission.
✔ If unsure, consult an immigration attorney before filing.
Should Form I-693 Be Submitted with I-485?
✔ Current USCIS Policy:
- Filing I-693 with I-485 is recommended to speed up processing.
- Previously, applicants could submit I-693 later in response to an RFE, but USCIS now prefers concurrent filing.
Final Takeaway
✔ Form I-693 is mandatory for Green Card applicants to prove they meet U.S. health standards.
✔ Find a USCIS-designated civil surgeon and complete the medical exam early.
✔ Follow all vaccine & testing requirements to avoid processing delays.
✔ Submit I-693 with I-485 to streamline USCIS processing.
Finding a USCIS-Designated Civil Surgeon
To locate a qualified physician authorized to conduct immigration medical examinations:
- USCIS “Find a Doctor” Tool:
- Visit the official USCIS website and use the Find a Civil Surgeon tool.uscis.gov
- Contact USCIS Directly:
- Call the USCIS Contact Center at 1-800-375-5283 for assistance in locating a civil surgeon in your area.USCIS+2uscis.gov+2uscis.gov+2
- Consult Local Health Departments:
- Some state and local health departments may have physicians authorized to perform immigration medical exams.uscis.gov
- Contact your local health department to inquire about available services.
- Ask Your Primary Care Physician:
- Inquire if your doctor holds this designation or can recommend a colleague who does.
Preparation for the Medical Examination:
- Schedule an Appointment: Once you’ve identified a civil surgeon, contact their office to schedule your medical examination.
- Gather Necessary Documents:
- Government-issued photo ID (e.g., passport, driver’s license).
- Vaccination records and any pertinent medical history.
- Form I-693, if you’ve already obtained it; otherwise, the civil surgeon will provide it.
- During the Examination:
- The civil surgeon will review your medical history, conduct a physical examination, and administer any required vaccinations or tests.
- After the Examination:
- The civil surgeon will complete and seal Form I-693 in an envelope.
- Important: Request a copy of the completed Form I-693 for your personal records before it is sealed. USCIS requires the sealed envelope for submission, but having a personal copy is beneficial for your records.
Preparing a Waiver Request for Medical or Religious Exemptions
If you seek an exemption from certain medical tests or vaccinations due to medical reasons or religious beliefs, follow these steps:
- Identify the Basis for Exemption:
- Medical Grounds: Conditions that contraindicate specific vaccinations or tests.
- Religious or Moral Grounds: Sincerely held beliefs opposing certain medical procedures.
- Complete Form I-601:
- Use Form I-601, Application for Waiver of Grounds of Inadmissibility, to request the exemption.
- Download the form and detailed instructions from the USCIS website.
- Gather Supporting Documentation:
- Medical Exemption:
- A detailed letter from a licensed physician explaining the medical condition and why it contraindicates specific vaccinations or tests.
- Religious or Moral Exemption:
- A personal statement detailing your beliefs and how they conflict with the medical requirements.
- Supporting letters from religious leaders or community members attesting to the sincerity of your beliefs.
- Medical Exemption:
- Submit the Waiver Application:
- Ensure all sections of Form I-601 are completed accurately.
- Attach all supporting documents.
- Include the required filing fee or Form I-912 if requesting a fee waiver.
- Mail the application to the appropriate USCIS address as specified in the Form I-601 instructions.
- Await USCIS Decision:
- USCIS will review your waiver request and may request additional information.
- Processing times can vary; refer to the USCIS processing times page for current estimates.
Note: Approval of a waiver is at the discretion of USCIS and is based on the evidence provided.
Age-Based Exemptions for Vaccinations on Form I-693
Certain vaccines required for Form I-693 are not necessary for individuals who fall outside the age ranges recommended by the Centers for Disease Control and Prevention (CDC). This means that children and elderly applicants may be exempt from certain vaccinations based on their age.
1. How Age Determines Vaccination Requirements
The CDC’s Advisory Committee on Immunization Practices (ACIP) provides age guidelines for vaccinations, which USCIS follows when determining which vaccines are required for adjustment of status applicants. If an individual is too young or too old for a specific vaccine, they are not required to receive it as part of the immigration medical examination.
Examples of Vaccines with Age-Based Exemptions
| Vaccine | Not Required For |
|---|---|
| Rotavirus | Children 6 months and older |
| Haemophilus Influenzae Type B (Hib) | Individuals 5 years and older |
| Hepatitis A | Individuals older than 18 years |
| Hepatitis B | No age-based exemption (required for all ages) |
| Polio (IPV/OPV) | Individuals 18 years and older |
| MMR (Measles, Mumps, Rubella) | Children younger than 12 months |
| Varicella (Chickenpox) | Individuals born before 1980 (considered immune) |
| Pneumococcal (PCV & PPSV) | Adults younger than 65 without risk factors |
| Influenza (Flu Vaccine) | Children younger than 6 months |
| COVID-19 Vaccine | Children younger than 6 months |
2. How Are These Exemptions Determined?
- The civil surgeon conducting the medical exam will determine if a specific vaccine is not required due to the applicant’s age.
- If an applicant falls outside the recommended age range, the civil surgeon will mark “Not Age Appropriate” on Form I-693 in the vaccination section.
- No additional documentation or waiver is needed if the exemption is solely based on age.
3. What If an Applicant is Close to the Required Age?
- If an applicant is approaching the required age for a vaccine at the time of the medical exam, the civil surgeon may require them to take it.
- If the applicant just turned an age where the vaccine is no longer required, they may still receive the exemption if it is not medically necessary.
4. Special Considerations for Elderly Applicants
✔ Varicella (Chickenpox) Exemption:
- Applicants born before 1980 are considered immune to chickenpox and are not required to receive the Varicella vaccine.
- If there is doubt, the civil surgeon may order a blood test (titer) to confirm immunity.
✔ Pneumococcal Vaccine:
- This vaccine is only required for older adults (65+ years) or younger adults with risk factors.
- If an elderly applicant does not fall within the CDC-recommended age group, the civil surgeon may exempt them from this requirement.
✔ Influenza (Flu) Vaccine:
- The seasonal flu vaccine is required only during flu season (October 1 – March 31).
- Elderly applicants must receive the flu vaccine if applying during these months, unless they have a valid medical exemption.
5. Do Applicants Need to File a Waiver for Age-Based Exemptions?
✔ No waiver is needed for age-based exemptions.
✔ The civil surgeon will simply mark the vaccine as “Not Age Appropriate” on Form I-693.
Key Takeaways
✔ Children and elderly applicants are exempt from certain vaccines based on CDC guidelines.
✔ No waiver is needed—the civil surgeon will mark “Not Age Appropriate” on Form I-693.
✔ Varicella, Polio, Rotavirus, and Pneumococcal vaccines have specific age limits.
✔ Flu vaccines are seasonal and may be waived if applying outside flu season.
Requesting a Vaccination Waiver Based on Religious Beliefs or Moral Convictions for Form I-693
Under U.S. immigration law, applicants seeking a Green Card (adjustment of status) may be exempted from required vaccinations if they have a sincerely held religious belief or moral conviction that prevents them from receiving certain vaccines. This exemption applies to vaccines required under the immigration medical examination process (Form I-693).
1. Legal Basis for Religious or Moral Exemptions
The Immigration and Nationality Act (INA) Section 212(a)(1)(A)(ii) requires certain vaccinations for individuals seeking to immigrate to the United States. However, Section 212(g)(2)(C) provides a waiver for applicants who oppose vaccinations based on sincerely held religious beliefs or moral convictions. This provision has been part of the INA since its amendments in 1996 under the Illegal Immigration Reform and Immigrant Responsibility Act (IIRIRA). Therefore, USCIS has allowed vaccine exemptions on religious or moral grounds since at least 1996.
- The Immigration and Nationality Act (INA) Section 212(a)(1)(A)(ii) allows applicants to seek waivers for vaccine requirements if they meet the legal criteria.
- USCIS grants these waivers on a case-by-case basis after reviewing sufficient evidence.
- To request a waiver, applicants must file Form I-601 (Application for Waiver of Grounds of Inadmissibility).
2. Criteria for a Religious or Moral Vaccination Waiver
To be eligible for a religious or moral exemption, an applicant must demonstrate:
✔ A deeply held religious or moral objection to vaccines.
✔ A consistent objection to all vaccines—not just a selective refusal of certain ones.
✔ Genuine and sincere beliefs (not based on convenience or misinformation).
❌ Personal preference, fear of side effects, or political objections do NOT qualify for a religious or moral exemption.
3. How to Apply for a Religious or Moral Vaccination Waiver
Step 1: Complete Form I-601
- Applicants must file Form I-601, Application for Waiver of Grounds of Inadmissibility with USCIS.
- The filing fee for Form I-601 is currently $930 (fee waivers may be available if eligible).
Step 2: Provide a Detailed Personal Statement
The applicant must submit a written statement explaining: ✔ The nature of their religious belief or moral conviction.
✔ How long they have held this belief.
✔ Whether they oppose all vaccinations (USCIS will deny the waiver if the applicant selectively refuses only certain vaccines).
✔ Whether they belong to a religious group that opposes vaccinations (though individual belief is also acceptable).
Step 3: Submit Supporting Evidence
- Affidavits from religious leaders confirming the applicant’s beliefs.
- Affidavits from family or community members who can attest to the sincerity of the applicant’s beliefs.
- Personal history demonstrating adherence to religious/moral convictions (e.g., history of declining vaccines for children or self).
Step 4: Civil Surgeon Documentation
- The civil surgeon conducting the immigration medical exam will note that the applicant has not received certain required vaccines.
- The civil surgeon CANNOT approve the waiver but must document the applicant’s refusal due to religious/moral reasons.
Step 5: USCIS Review and Decision
- USCIS evaluates the sincerity of the applicant’s beliefs.
- If approved, the applicant is exempted from the vaccine requirement.
- If denied, the applicant must complete the vaccinations or risk denial of their Green Card application.
4. Possible Challenges or Reasons for Denial
❌ If USCIS determines the objection is not sincere (e.g., based on personal preference, misinformation, or selective refusal).
❌ If the applicant is willing to receive some vaccines but not others (waivers apply only to those who refuse all vaccines on principle).
❌ If the applicant fails to provide strong supporting evidence (lack of affidavits or clear explanation).
5. Key Takeaways
✔ Religious/moral waivers are available for vaccine exemptions on Form I-693 but require strong evidence.
✔ Applicants must oppose all vaccines based on sincere beliefs—selective refusals are not accepted.
✔ Form I-601 and a personal statement must be submitted to USCIS for approval.
✔ Affidavits from religious leaders or community members strengthen the application.
✔ USCIS makes the final decision based on evidence and credibility.
Template for a Religious or Moral Exemption Waiver Request (Form I-601) for Vaccinations
This template is for applicants seeking a religious or moral exemption from required vaccinations for Form I-693 (Immigration Medical Exam). It should be submitted along with Form I-601 (Application for Waiver of Grounds of Inadmissibility).
[Applicant’s Full Name]
[Address]
[City, State, ZIP Code]
[Date]
To:
U.S. Citizenship and Immigration Services (USCIS)
[Service Center Address – based on USCIS instructions]
Subject: Request for Vaccination Exemption Based on Religious/Moral Beliefs
Dear USCIS Officer,
I, [Full Name], am submitting this letter to formally request a waiver of the vaccination requirements as part of my adjustment of status application. I am applying under INA Section 212(g)(2)(C), which allows individuals to seek an exemption from vaccinations based on sincerely held religious or moral convictions.
1. My Sincerely Held Religious/Moral Belief
I have a deeply held religious/moral conviction that prohibits me from receiving vaccinations. My belief is not based on scientific concerns, medical reasons, or personal preference, but rather on my firm religious/moral principles, which guide my entire way of life.
I firmly believe that introducing vaccines into my body violates my faith/moral doctrine because [explain briefly: example—“I believe in the natural sanctity of the human body as created by God and that altering it with vaccines is against divine will.”] My religious/moral opposition extends to all vaccines and is not selective in nature.
2. Consistency of My Belief
I have held this belief for [X] years, and it has influenced many aspects of my life, including my medical decisions. I have consistently declined vaccinations for myself and my family due to my convictions. I do not make exceptions to this belief, and it is not influenced by convenience, social trends, or medical opinions.
3. Supporting Documentation
To further demonstrate the sincerity of my belief, I am including:
- Affidavit from a religious leader ([Religious Leader’s Name] of [Religious Institution Name]) affirming that my religious doctrine prohibits vaccinations.
- Personal affidavit from family/friends who can confirm my longstanding religious/moral opposition to vaccines.
- Records of past vaccine refusals (if available, such as school exemption documents).
4. Acknowledgment of Health Risks
I fully understand the potential health implications of not receiving vaccinations. However, my beliefs compel me to remain steadfast in my conviction. I am willing to comply with all other medical examination requirements and public health guidelines that do not contradict my faith/morals.
5. Request for Consideration
I respectfully request that USCIS grant my religious/moral vaccination waiver based on the sincerity and consistency of my beliefs. I affirm that my objection to vaccinations is absolute and is an integral part of my religious/moral values.
Thank you for considering my request. Please feel free to contact me if additional information is required.
Sincerely,
[Full Name]
[Applicant’s Signature]
[Alien Registration Number (if available)]
Additional Documents to Include with Form I-601
📌 Affidavits from Religious Leaders or Community Members
📌 Personal Affidavit Detailing Longstanding Religious/Moral Beliefs
📌 Any Prior Vaccine Exemption Approvals (if available)
📌 Medical Exam (Form I-693) Showing Vaccines Not Administered Due to Religious/Moral Objection
Conclusion
Form I-693, Report of Medical Examination and Vaccination Record, is a mandatory requirement for Green Card applicants to ensure they meet U.S. public health standards. The USCIS-designated civil surgeon conducts the medical examination, which includes screening for communicable diseases, mental health conditions, drug abuse, and required vaccinations.
✔ Age-based and medical exemptions apply for certain tests and vaccines.
✔ Religious or moral vaccine waivers are available through Form I-601, but applicants must prove sincerely held beliefs.
✔ The medical exam results are sealed and submitted to USCIS, and applicants should request a personal copy before sealing.
✔ USCIS now encourages submitting Form I-693 with Form I-485 to avoid processing delays and minimize the risk of a Request for Evidence (RFE).
✔ Applicants should ensure timely medical exams, accurate documentation, and compliance with vaccination requirements to avoid delays in their Green Card processing.
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