Immediate Relative Status and the Medical Exam

Spouses of U.S. citizens are classified as immediate relatives under the Immigration and Nationality Act. This is the most favorable family-based immigration category because there is no annual visa quota — a visa number is always immediately available. This means eligible spouses can often file Form I-485 concurrently with or shortly after the I-130 petition.

Despite the expedited availability of visa numbers, the immigration medical exam requirement is the same as for all other adjustment of status applicants. You must complete an examination with a USCIS-designated civil surgeon and submit Form I-693 as part of your I-485 package.

What the Medical Exam Includes

The civil surgeon will perform a complete physical examination, review your medical history, conduct TB testing (skin test or IGRA blood test), order required laboratory tests including syphilis serology and gonorrhea culture (for applicants aged 15 and older), and review your vaccination records.

Any vaccines required by USCIS that you have not yet received will be administered at the appointment or at a follow-up visit. The civil surgeon then completes Form I-693, seals it in an envelope, and provides it to you for submission to USCIS.

• Complete physical examination
• Medical history review
• TB skin test or IGRA blood test
• Syphilis and gonorrhea testing (age 15+)
• Vaccination review and administration of missing vaccines
• Completion and sealing of Form I-693

Timing Your Exam as a Spouse of a U.S. Citizen

Because immediate relatives can file I-485 as soon as the I-130 is approved (or concurrently in some cases), many spouses of U.S. citizens complete the medical exam at the time of I-485 filing. This allows them to submit a complete application package to USCIS from the start.

Remember that Form I-693 must be signed by the civil surgeon no more than 60 days before you submit it to USCIS, and it is valid for two years from the civil surgeon's signature date. Plan your exam timing accordingly to ensure I-693 is within its validity window when USCIS adjudicates your case.

What to Bring to Your Appointment

Bring your passport or government-issued photo ID, your vaccination records (if available), and any relevant medical records for chronic conditions. If you do not have vaccination records, the civil surgeon can order titer tests to check immunity or administer vaccines as needed. You do not need to bring your I-485 filing receipt to the medical exam appointment.