I-693 Medical Exam for Children Under 18 (2026 Guide)

The I-693 medical exam for children under 18 covers a physical exam, an age-based tuberculosis screening, and a review of the child's vaccination record, with several steps handled differently than for an adult applicant. Younger children skip parts of the exam that adults must complete, but vaccination review tends to take longer because school and pediatrician records are often incomplete.

Why the I-693 exam works differently for children

USCIS applies the same Form I-693 to every applicant, but the underlying CDC Technical Instructions use age brackets to decide what testing is medically necessary. A 4-year-old and a 17-year-old go through different versions of the same form. Parents who expect the exam to look exactly like an adult physical are usually surprised by how much of the visit focuses on the vaccination record instead of lab work.

Families scheduling exams for multiple children also run into a logistics problem adults rarely face: coordinating school shot records, pediatrician files, and sometimes records from another country, all before one appointment. A dedicated immigration medical exam clinic that handles child exams regularly knows which age-based rules apply and can flag missing pieces before the appointment day, not during it.

Confirm the child's age bracket before scheduling

Age determines which parts of Form I-693 apply, and it's worth confirming this before you book anything.

• Children under 2 years old are exempt from tuberculosis testing under current CDC Technical Instructions.
• Children 2 through 14 generally require a TB blood test (IGRA), with a chest x-ray only if that test comes back positive.
• Children 15 and older follow the same TB and blood test protocol as adult applicants.
• Blood tests for syphilis and gonorrhea are not required under age 15 unless there's evidence of abuse or risk factors.
• Vaccination requirements based on the ACIP schedule apply to every age, including infants.

Gather the child's vaccination record

This is the step that slows down more child exams than any other. Start early.

• Request the official immunization record from the child's pediatrician or school nurse's office.
• Ask for a printed or digital copy, not just a verbal summary of what shots the child received.
• If the child was vaccinated outside the U.S., bring the original foreign-language record along with any translation available.
• Note the exact dates of each vaccine, since USCIS requires dates, not just vaccine names.
• Bring records for every vaccine the child has ever received, even ones that seem outdated or irrelevant.

Prepare for the TB screening step

Parents often assume a toddler needs the same TB skin test an adult gets. That's usually not true.

• Confirm your child's exact age on the day of the exam, since the 2-year cutoff is strict.
• For children 2-14, expect a blood draw (IGRA) rather than a skin test in most clinics.
• Ask whether a recent TB test from a pediatrician can be used, since a duplicate test is sometimes avoidable.
• If a chest x-ray becomes necessary after a positive blood test, ask about shielding and timing for young children.
• Bring any prior TB test results or documentation of a past positive test, since this changes the workup.

Complete the physical exam portion

The hands-on physical exam still happens at every age, though it's brief for most children.

• Expect a general health assessment: growth, vision screening where applicable, and a basic physical check.
• Bring a list of any current medications, allergies, or chronic conditions the child has.
• Mention any developmental or medical diagnoses that could affect the civil surgeon's notes on Form I-693.
• For infants, bring feeding and growth information from the pediatrician if available.
• Expect this portion to take far less time than the vaccination review for most children.

Review vaccination gaps with the civil surgeon

Once the record is in hand, the civil surgeon checks it against the ACIP schedule for the child's age.

• Ask the civil surgeon to walk through which vaccines are missing versus which are current.
• Clarify which missing vaccines are medically required for Form I-693 and which are optional at this age.
• Ask about exemptions if a vaccine is contraindicated for a medical reason, which requires separate documentation.
• Bring a religious or medical exemption form in advance if one applies, rather than requesting it during the visit.
• Get a written summary of exactly what's missing before you leave the visit.

Handle catch-up vaccines the same day when possible

Many clinics, including ImmigrationMedicalExams.com, can administer required catch-up vaccines during the same appointment.

• Ask in advance whether same-day vaccination is available for the missing shots your child needs.
• Confirm there's no conflicting vaccine given too recently that would delay a second dose.
• Ask how multi-dose vaccine series (like Hepatitis B) are handled if the child hasn't started the series.
• Bring any allergy history relevant to vaccine components before vaccines are given.
• Reading current USCIS vaccination requirements for Form I-693 before the visit helps you ask sharper questions on the day.

Get Form I-693 completed and sealed

Once testing, vaccination review, and the physical exam are done, the civil surgeon finalizes the form.

• Confirm the civil surgeon has the child's full legal name and date of birth exactly as they appear on immigration paperwork.
• Ask how the completed form is sealed and whether it's handed to you or sent directly, since sealed I-693 packets typically require specific mailing or filing steps.
• Do not open the sealed envelope; USCIS requires it stay sealed until they open it.
• Standard completion takes 3 business days; a 2-day expedited option is available when scheduling, lab results, and vaccination requirements allow it.
• Keep a copy of any receipts or vaccine records given to you separately from the sealed form.

Plan for siblings or multiple children in one visit

Families with more than one child applying often try to schedule everyone in a single appointment window.

• Ask whether the clinic can see multiple children back-to-back on the same day.
• Bring separate vaccination records for each child, even for twins or children close in age.
• Expect the visit to take longer overall, even though each child's individual exam may be brief.
• If one child has an urgent USCIS deadline, ask about a same-day appointment for urgent deadlines rather than assuming every sibling needs the exact same timeline.
• A pre-visit telehealth pre-screening can flag missing records for each child before anyone sets foot in the clinic.

Comparing exam options for families with children

Option	Best for	Turnaround	Key limitation
Standard child exam appointment	One child, records already complete	3 business days	Slower if vaccination record is incomplete
Expedited child exam appointment	Urgent USCIS deadline, complete records	2 business days	Only available when labs and vaccines don't require extra time
Family group appointment	Two or more children applying together	Varies by group size	Requires each child's own vaccination record on hand
Exam correcting prior incomplete paperwork	Child whose I-693 was filled out wrong elsewhere	Depends on what must be redone	May require repeating tests already paid for once

Verdict: for most families, a standard appointment with the child's complete vaccination record in hand is the fastest and least stressful path through the I-693 medical exam for children under 18.

Common mistakes families make with a child's I-693 exam

• Assuming a toddler needs a TB skin test. Children under 2 are exempt from TB testing entirely under current CDC guidance.
• Forgetting adopted or foster children need the same vaccination review. Immigration status doesn't change the age-based requirements.
• Bringing an untranslated foreign vaccination record. A record in another language without any translation slows down review.
• Skipping catch-up vaccines because the child "seems healthy." USCIS checks against a specific age-based vaccine schedule, not general wellness.
• Underestimating the time needed for multiple children. Each child needs their own record review even in one family visit.

FAQ

One last thing

The part of a child's I-693 medical exam that catches families off guard isn't a needle or a test result, it's the paperwork trail. A vaccination record with one missing date can hold up a child's Form I-693 longer than an actual positive TB test would, because a positive test has a clear next step and a missing record often means calling a pediatrician's office and waiting days for a callback. Request the full immunization record before you book the appointment, not after.

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