Immigration Medical Exam Encyclopedia
Complete A–Z reference guide to every term, test, vaccine, and form you will encounter during your immigration medical exam and green card application.
A
Adjustment of Status
Adjustment of Status is the process by which a person already in the United States applies to become a lawful permanent resident (green card holder) without leaving the country. The primary application form is Form I-485. As part of the I-485 package, most applicants must submit a completed immigration medical exam on Form I-693, completed and signed by a USCIS-designated Civil Surgeon. The medical exam must be current — generally completed within two years of the Civil Surgeon's signature — when USCIS adjudicates the case.
Who needs an immigration medical exam?Admissibility
Admissibility refers to whether a foreign national is eligible to enter or remain in the United States under immigration law. Health-related grounds of inadmissibility include: (1) having a communicable disease of public health significance (such as active tuberculosis or syphilis); (2) having a physical or mental disorder with associated harmful behavior; and (3) being a drug abuser or addict. The immigration medical exam is the mechanism by which USCIS evaluates these health-related grounds. A finding of inadmissibility does not always result in denial — waivers may be available.
B
BCG Vaccine
BCG (Bacille Calmette-Guérin) is a tuberculosis vaccine widely used in many countries outside the United States. BCG vaccination commonly causes a false-positive result on the tuberculin skin test (TST/PPD), making it difficult to interpret TST results in BCG-vaccinated individuals. For this reason, USCIS guidelines and most Civil Surgeons prefer the IGRA (Interferon-Gamma Release Assay) blood test — such as QuantiFERON-TB Gold — for TB screening in BCG-vaccinated applicants. IGRA is not affected by prior BCG vaccination and produces far fewer false positives.
What if I had the BCG vaccine?C
CDC Vaccine Requirements
The Centers for Disease Control and Prevention (CDC) sets immigration vaccination policy in coordination with the Advisory Committee on Immunization Practices (ACIP). Under the Immigration and Nationality Act, USCIS requires all vaccines recommended by ACIP that are age-appropriate and medically appropriate for the applicant. The CDC's Technical Instructions for Civil Surgeons translate ACIP recommendations into the specific vaccination requirements that Civil Surgeons must follow when completing Form I-693. These requirements are updated periodically as ACIP adds new vaccines to its recommended schedule.
USCIS vaccination requirements overviewChest X-Ray
A chest X-ray is required during the immigration medical exam when an applicant has a positive TB test result (TST or IGRA) and is age 15 or older. The chest X-ray screens for pulmonary tuberculosis — specifically for signs of active TB disease such as infiltrates, cavities, or nodules. It is also used to evaluate applicants with a history of TB or TB treatment. The radiation dose from a standard chest X-ray is very low (approximately 0.1 mSv) and is considered safe for most adults. Pregnant women may have the exam deferred or shielded depending on clinical circumstances.
Do I need a chest X-ray for immigration?Civil Surgeon
A Civil Surgeon is a physician designated by USCIS to perform immigration medical examinations and complete Form I-693. Only USCIS-designated Civil Surgeons are authorized to conduct immigration medical exams — your personal physician, urgent care doctor, or any non-designated provider cannot complete Form I-693. Civil Surgeons must be licensed physicians (MD or DO) who have applied to USCIS and met specific training and compliance requirements. To find a Civil Surgeon, use the USCIS Civil Surgeon locator at uscis.gov/civil-surgeons, or contact our clinic directly.
What is a Civil Surgeon?Communicable Disease of Public Health Significance
Under the Immigration and Nationality Act (INA § 212(a)(1)(A)(i)), a foreign national who has a communicable disease of public health significance is inadmissible. The current list of designated communicable diseases includes: active tuberculosis (TB), syphilis (infectious stage), gonorrhea, Hansen's disease (leprosy — infectious), and any quarantinable communicable disease designated by Presidential Executive Order. Having one of these conditions does not automatically result in permanent denial — treatment, follow-up, and in some cases waivers are available. The Civil Surgeon documents the presence or absence of these conditions on Form I-693.
COVID-19 Vaccine
COVID-19 vaccination is currently required for immigration medical exams. USCIS requires applicants to receive a COVID-19 vaccine series that is accepted by the CDC for immigration purposes. Accepted vaccines include those authorized or approved by the FDA as well as certain WHO-listed vaccines. The specific dose requirements depend on the vaccine brand and the applicant's age. If you have already received a COVID-19 vaccine series, bring your vaccination card or documentation to your appointment.
COVID-19 vaccine requirements for immigrationD
Drug Abuse Screening
During the immigration medical exam, the Civil Surgeon screens for drug abuse and addiction as part of the mental health and substance use evaluation. USCIS screens for substance use disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM). A current diagnosis of a substance use disorder — including alcohol use disorder — can be a ground of inadmissibility if it is associated with harmful behavior. Past substance use that is in remission and not associated with current harmful behavior is generally not a bar to admissibility. The Civil Surgeon documents findings on Form I-693 and may refer the applicant for further evaluation.
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No entries for this letter. See adjacent letters.
F
False Positive TB Test
A false positive TB test result occurs when a tuberculin skin test (TST/PPD) reads positive but the person does not actually have tuberculosis infection. The most common cause of false positive TST results in immigration applicants is prior BCG vaccination, which is standard in many countries. Other causes include infection with non-tuberculous mycobacteria. When a false positive is suspected — particularly in BCG-vaccinated individuals — the preferred approach is to perform an IGRA (Interferon-Gamma Release Assay) blood test such as QuantiFERON-TB Gold, which is not affected by BCG vaccination. If the IGRA is negative, the positive TST is considered a false positive and no further TB workup is required.
What if I had the BCG vaccine?G
See Gonorrhea Testing and Green Card Medical Exam under the H section below.
H
Foreign Vaccine Records
Vaccination records from outside the United States are accepted by Civil Surgeons during the immigration medical exam. Bring any official documentation of vaccines received abroad — including the yellow WHO International Certificate of Vaccination, national immunization booklets, school records, or physician records. If records are in a foreign language, a translation may be helpful but is not always required. When records are incomplete or unavailable, the Civil Surgeon may order serologic (blood) titer testing to check for immunity to certain diseases such as MMR, Varicella, and Hepatitis B. If immunity is confirmed by titers, the vaccine is not required even without documentation.
Foreign vaccine records for immigrationForm I-485
Form I-485 (Application to Register Permanent Residence or Adjust Status) is the primary USCIS form used to apply for a green card from within the United States. Form I-693 (the immigration medical exam) is a required supporting document for most I-485 applications. The I-693 can be submitted with the initial I-485 filing or separately — either mailed directly to USCIS or brought to an interview. The I-693 must be current (generally within two years of the Civil Surgeon's signature) when USCIS adjudicates the I-485.
Form I-693
Form I-693 (Report of Immigration Medical Examination and Vaccination Record) is the official USCIS form used to document the results of an immigration medical exam. It is completed and signed by a USCIS-designated Civil Surgeon — not by the applicant. The completed form must be placed in a sealed envelope by the Civil Surgeon and must remain sealed until submitted to USCIS. Opening the sealed envelope invalidates the form. Form I-693 is generally valid for two years from the date of the Civil Surgeon's signature.
Complete guide to Form I-693Gonorrhea Testing
Gonorrhea testing is required for all immigration medical exam applicants age 15 and older. The standard test is a NAAT (Nucleic Acid Amplification Test), which is highly sensitive and specific. Gonorrhea is a communicable disease of public health significance under the INA, meaning a positive result can affect admissibility. However, gonorrhea is treatable — applicants with a positive result are typically referred for treatment, and after completing treatment and confirming cure, the finding is resolved. The Civil Surgeon documents the test result and any follow-up on Form I-693.
Why is gonorrhea testing required?Green Card Medical Exam
"Green card medical exam" is a common informal term for the immigration medical examination required as part of the adjustment of status (green card) application process. The exam is formally documented on Form I-693 and must be performed by a USCIS-designated Civil Surgeon. It includes a physical examination, review of vaccination history, TB testing, and laboratory tests for communicable diseases. The terms "immigration medical exam," "USCIS medical exam," and "green card medical exam" all refer to the same examination.
Who needs an immigration medical exam?I
Hepatitis B
Hepatitis B vaccination is required for all immigration medical exam applicants. The standard series consists of three doses. If you have documentation of prior Hepatitis B vaccination, bring it to your appointment. If records are unavailable, the Civil Surgeon may order a Hepatitis B surface antibody (anti-HBs) titer test to confirm immunity — if immunity is confirmed, the vaccine series is not required. The exam also includes a Hepatitis B surface antigen (HBsAg) test to screen for active Hepatitis B infection, which is a reportable condition documented on Form I-693.
Hepatitis B vaccine for immigrationIGRA (Interferon-Gamma Release Assay)
An IGRA (Interferon-Gamma Release Assay) is a blood test used to detect tuberculosis infection. The most widely used IGRA in the United States is QuantiFERON-TB Gold (QFT). IGRAs work by measuring the immune system's response to TB antigens in a blood sample. Unlike the tuberculin skin test (TST/PPD), IGRAs are not affected by prior BCG vaccination and produce fewer false positive results. For this reason, IGRAs are the preferred TB screening method for immigration medical exams, particularly for BCG-vaccinated applicants. A positive IGRA indicates TB infection (latent or active) and triggers further evaluation including a chest X-ray.
What is the IGRA test?Immigration Medical Examination
The immigration medical examination is a comprehensive health evaluation required by USCIS for most green card applicants. It must be performed by a USCIS-designated Civil Surgeon and documented on Form I-693. The exam includes: (1) a complete physical examination; (2) review and verification of vaccination history; (3) TB testing (IGRA blood test and/or chest X-ray); (4) laboratory tests for communicable diseases (syphilis RPR, gonorrhea NAAT, Hepatitis B surface antigen); and (5) mental health and substance use screening. The entire exam typically takes 30–60 minutes, with lab results available within 1–3 business days.
Step-by-step immigration medical exam processInfluenza Vaccine
The influenza (flu) vaccine is required for all immigration medical exam applicants age 6 months and older. Because influenza vaccines are updated annually to match circulating strains, the requirement is seasonal — typically from October through March (the Northern Hemisphere flu season). If your appointment falls outside flu season and the current season's vaccine is not yet available, the Civil Surgeon will document this on Form I-693. Bring documentation of any flu vaccine received in the current season to your appointment.
Influenza vaccine requirements for immigrationJ
No entries for this letter. See adjacent letters.
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No entries for this letter. See adjacent letters.
L
Latent Tuberculosis
Latent tuberculosis infection (LTBI) means a person has TB bacteria in their body but the bacteria are inactive and not causing symptoms. People with LTBI are not contagious and cannot spread TB to others. LTBI is detected by a positive IGRA or TST result with a normal chest X-ray. Unlike active TB, latent TB is not a communicable disease of public health significance and does not automatically make an applicant inadmissible. However, USCIS may require documentation of LTBI treatment or a treatment plan as a condition of approval. Treatment for LTBI (typically a 3–9 month course of antibiotics) significantly reduces the risk of developing active TB disease.
Latent TB vs. active TB for immigrationM
See entries below (Medical Waiver, Mental Health Evaluation, MMR Vaccine).
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No entries for this letter. See adjacent letters.
O
No entries for this letter. See adjacent letters.
P
Polio Vaccine
The inactivated poliovirus vaccine (IPV) is required for immigration medical exam applicants. The standard series consists of four doses, typically administered in childhood. Adults who completed a primary series as children generally do not need additional doses unless they are at increased risk. If you received the oral poliovirus vaccine (OPV) — which was used in many countries before being phased out — your Civil Surgeon will evaluate whether your series is considered complete under current USCIS guidelines. Bring all vaccination records documenting your polio vaccine history.
Polio vaccine for immigrationQ
QuantiFERON-TB Gold
QuantiFERON-TB Gold (QFT) is the most widely used IGRA blood test for tuberculosis screening in immigration medical exams. It works by measuring the amount of interferon-gamma released by white blood cells when exposed to TB-specific antigens in a blood sample. Results are reported as positive, negative, or indeterminate. A positive result indicates TB infection (latent or active) and requires further evaluation including a chest X-ray. QuantiFERON-TB Gold is the preferred TB test for immigration because it is not affected by prior BCG vaccination, requires only a single patient visit (no return visit to read results), and has high sensitivity and specificity.
What is the IGRA (QuantiFERON) test?R
RPR Test
The RPR (Rapid Plasma Reagin) test is a blood test used to screen for syphilis. It is required for all immigration medical exam applicants age 15 and older. A reactive (positive) RPR result indicates possible syphilis infection and requires confirmatory testing (typically a treponemal test such as FTA-ABS or TP-PA). Syphilis in its infectious stages is a communicable disease of public health significance under the INA. However, syphilis is treatable — applicants with confirmed syphilis are referred for treatment, and after completing treatment and confirming cure, the finding is resolved on Form I-693.
Why is syphilis testing required?S
Sealed Envelope Rule
The sealed envelope rule requires that Form I-693 be placed in a sealed envelope by the Civil Surgeon and remain sealed until it is submitted to USCIS. The Civil Surgeon signs across the seal of the envelope. If the envelope is opened by anyone — including the applicant, their attorney, or any other party — the form is considered invalid and a new immigration medical exam must be performed. The purpose of the sealed envelope rule is to maintain the integrity and confidentiality of the medical findings. USCIS officers open the envelope when adjudicating the case.
Understanding the sealed envelope ruleSyphilis Testing
Syphilis testing via the RPR blood test is required for all immigration medical exam applicants age 15 and older. Syphilis in its infectious stages (primary, secondary, and early latent) is a communicable disease of public health significance under the INA, meaning active infectious syphilis can affect admissibility. However, syphilis is curable with antibiotics (typically penicillin). Applicants with a confirmed syphilis diagnosis are referred for treatment; after completing treatment and confirming serologic response, the Civil Surgeon can document resolution on Form I-693. Late latent syphilis (more than one year duration) and tertiary syphilis are not considered communicable and do not affect admissibility.
Why is syphilis testing required?T
Tdap Vaccine
The Tdap vaccine (Tetanus, Diphtheria, and Pertussis) is required for all immigration medical exam applicants. Adults need one dose of Tdap followed by a Td (Tetanus-Diphtheria) booster every 10 years. If you received a Td booster within the past 10 years but have never received Tdap, you will need a Tdap dose. Pregnant applicants should receive Tdap during each pregnancy (ideally between 27–36 weeks gestation) to protect the newborn from pertussis. Bring documentation of any prior Tdap or Td vaccinations to your appointment.
Tdap vaccine requirements for immigrationTuberculosis
Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis that primarily affects the lungs. TB testing is required for all immigration medical exam applicants age 2 and older. The preferred test is the IGRA blood test (QuantiFERON-TB Gold). A positive TB test triggers a chest X-ray to distinguish between latent TB (inactive, non-contagious) and active TB disease (potentially contagious, inadmissible). Active TB is a communicable disease of public health significance and requires treatment before the immigration case can proceed. Latent TB is not inadmissible but may require documentation of treatment or a treatment plan.
Tuberculosis and immigration — complete guideU
No entries for this letter. See adjacent letters.
V
No entries for this letter. See adjacent letters.
W
No entries for this letter. See adjacent letters.
X
No entries for this letter. See adjacent letters.
Y
No entries for this letter. See adjacent letters.
Z
No entries for this letter. See adjacent letters.
Additional entries — the following terms (Medical Waiver, Mental Health Evaluation, MMR Vaccine) are listed here for reference and are also accessible via the M index link above.
Medical Waiver
A medical waiver (Form I-601, Application for Waiver of Grounds of Inadmissibility) may be available to applicants who are found inadmissible on health-related grounds. Waivers are not available for all grounds of inadmissibility — for example, active TB typically requires treatment rather than a waiver. Waivers may be available for certain communicable diseases, mental health conditions, and substance use disorders depending on the specific circumstances, the applicant's family relationships, and other factors. The waiver process is separate from the immigration medical exam and is handled by USCIS. Consult an immigration attorney if you believe you may need a medical waiver.
Mental Health Evaluation
The immigration medical exam includes a mental health screening component. The Civil Surgeon screens for physical or mental disorders associated with harmful behavior — defined as behavior that has posed or is likely to pose a threat to the property, safety, or welfare of the applicant or others. Having a mental health diagnosis alone is not a ground of inadmissibility; the key factor is whether the disorder is associated with harmful behavior. If the Civil Surgeon identifies a concern, they may refer the applicant for further psychiatric evaluation. The Civil Surgeon also screens for substance use disorders as part of the mental health evaluation.
MMR Vaccine
The MMR vaccine (Measles, Mumps, Rubella) is required for all immigration medical exam applicants age 12 months and older. Two doses are required. Applicants born before 1957 are presumed to have natural immunity to measles and mumps and may be exempt from the MMR requirement. If you do not have documentation of two MMR doses, the Civil Surgeon may order serologic titer testing to check for immunity — if immunity to all three components is confirmed, the vaccine is not required. Bring all vaccination records documenting prior MMR doses to your appointment.
MMR vaccine requirements for immigrationKey Takeaways from This Encyclopedia
Frequently Asked Questions
Medical & Legal Disclaimer: The information in this encyclopedia is provided for general educational purposes only and does not constitute medical or legal advice. USCIS requirements, CDC guidelines, and immigration policies may change without notice. Always consult a USCIS-designated Civil Surgeon and a qualified immigration attorney for guidance specific to your individual case.
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