What Should an Immigration Attorney Do If a Client Refuses to Complete the Medical Exam?
Quick Answer
The immigration medical examination is mandatory for adjustment of status applicants. A client who refuses to complete the exam cannot have their I-485 approved. Attorneys should counsel clients on the mandatory nature of the exam, address any concerns, and explore whether a religious or medical exemption applies to specific vaccines.
The Medical Exam Is Mandatory
Form I-693 is a mandatory component of the adjustment of status process. USCIS will not approve an I-485 without a completed, valid Form I-693. There is no waiver of the medical examination requirement itself — only waivers for specific components, such as individual vaccines.
Attorneys should make clear to clients from the outset that the medical examination is not optional. A client who refuses to complete the exam is effectively refusing to complete their I-485 application.
Consequences of Refusal
If a client refuses to complete the medical examination, USCIS will issue an RFE requesting Form I-693. If the client continues to refuse, USCIS will deny the I-485 for failure to establish eligibility.
A denial based on failure to complete the medical examination can have significant consequences for the client's immigration status, including potential removal proceedings if the client is in the United States without lawful status.
Counseling Clients Who Are Reluctant
Clients may refuse or be reluctant to complete the medical examination for a variety of reasons, including fear of needles, concerns about privacy, fear of what the examination might reveal, or distrust of the medical system.
Attorneys should address these concerns directly. Explain that the civil surgeon is not an immigration officer and is not making immigration decisions. Emphasize that the examination is confidential and that the civil surgeon is bound by HIPAA. Address specific fears about needles or medical procedures by explaining what the examination involves.
Religious and Medical Exemptions for Vaccines
While the medical examination itself is mandatory, clients may be eligible for exemptions from specific vaccines. Medical contraindication exemptions are available for vaccines that are medically contraindicated. Religious or moral objection exemptions are available for clients who object to all vaccinations based on sincere religious beliefs or moral convictions.
These exemptions apply only to specific vaccines — not to the examination as a whole. A client who objects to vaccines can still complete the examination; the civil surgeon will document the exemption on Form I-693.
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