IR-3 vs. IR-4: Two Pathways for International Adoption

International adoption involves two main immigrant visa categories: IR-3 and IR-4. The IR-3 visa is issued to children who are fully adopted abroad before entering the United States — both adoptive parents (or the single adoptive parent) have seen the child in person before or during the adoption proceedings. The IR-4 visa is issued to children who will be adopted in the United States after entry.

The medical exam requirements differ significantly between these two categories.

IR-3 Visa: Overseas Exam and Automatic Citizenship

Children entering on an IR-3 immigrant visa complete an overseas medical examination with a panel physician before their visa is issued. This exam is conducted at a U.S. embassy or consulate abroad and results in Form DS-2053.

Children who enter on an IR-3 visa and whose adoptive parents are U.S. citizens automatically acquire U.S. citizenship upon entry under the Child Citizenship Act of 2000. Because they become U.S. citizens upon entry, they do not need to file I-485 and therefore do not need a domestic civil surgeon examination.

• IR-3: fully adopted abroad before entry
• Panel physician exam overseas (DS-2053)
• Automatic U.S. citizenship upon entry (if adoptive parent is U.S. citizen)
• No I-485 required — no civil surgeon exam required

IR-4 Visa: Domestic Adoption and Civil Surgeon Exam

Children entering on an IR-4 visa will be adopted in the United States after entry. These children do not automatically acquire U.S. citizenship upon entry. After the adoption is finalized in the United States, the adoptive parents must file Form I-485 on behalf of the child to adjust their status to lawful permanent residence.

IR-4 children who file I-485 must complete an immigration medical examination with a USCIS-designated civil surgeon and submit Form I-693. The exam follows age-appropriate protocols for the child's age at the time of the examination.

What to Bring to the Civil Surgeon Appointment

For IR-4 children filing I-485, bring the child's passport, birth certificate, adoption decree, and all available vaccination records (including records from the overseas exam). The civil surgeon will review the overseas exam results and vaccination records and administer any missing required vaccines. Parental consent is required for the examination.