A civil surgeon is a doctor designated by U.S. Citizenship and Immigration Services (USCIS) to perform medical examinations for people applying for permanent residency (a green card) from inside the United States. Despite the name, a civil surgeon is not a surgeon in the traditional sense. They are licensed physicians, either M.D.s or D.O.s, who have been specifically authorized to conduct the immigration medical exam and complete Form I-693, the official report that USCIS requires as part of an adjustment of status application.
Who Qualifies as a Civil Surgeon
Not every doctor can perform an immigration medical exam. To be designated by USCIS, a physician must hold an unrestricted medical license in the state where they plan to conduct exams and have at least four years of professional experience after completing all training. Internships and residencies do not count toward that four-year requirement, even if the doctor was already licensed during that period. The clock starts only when post-graduate training ends.
Nurse practitioners, physician assistants, chiropractors, podiatrists, and other healthcare professionals who are not licensed as M.D.s or D.O.s cannot be designated as civil surgeons or perform any part of the immigration exam.
Civil Surgeons vs. Panel Physicians
If you’re applying for a green card from within the United States, you see a civil surgeon. If you’re applying from outside the country (through a U.S. consulate or embassy), your medical exam is performed by a panel physician, a different category of doctor authorized by the U.S. Department of State. The exams cover similar ground, but the two designations serve different geographic jurisdictions and are managed by different agencies.
What Happens During the Medical Exam
The immigration medical exam evaluates four broad categories that could affect your admissibility to the United States: communicable diseases of public health significance, vaccination status, physical or mental disorders with a history of harmful behavior, and drug abuse or addiction.
For communicable disease screening, the civil surgeon is required to test for tuberculosis, syphilis, and gonorrhea. Everyone two years and older gets a TB screening test, typically a skin test or blood test. A positive result triggers a chest X-ray, and if that X-ray looks abnormal, the applicant is referred to the local health department for further evaluation. Gonorrhea testing is required for applicants aged 18 to 24, using a urine or swab sample. Syphilis testing follows age-based guidelines set by the CDC. The exam also includes an evaluation for other sexually transmitted infections and Hansen’s disease (leprosy).
The civil surgeon will also assess your mental health history, looking specifically for conditions that have been associated with harmful behavior. A substance use evaluation is part of this process as well.
Required Vaccinations
A significant portion of the exam involves verifying that you are up to date on vaccinations required by U.S. immigration law. The specific vaccines depend on your age. Adults generally need proof of vaccination against polio, measles, mumps, rubella, hepatitis B (through age 59), varicella (chickenpox), tetanus/diphtheria/pertussis, pneumococcal disease, and influenza (seasonally). Children have additional requirements including rotavirus, hepatitis A, and meningococcal vaccines.
If you have vaccination records from your home country, bring them. Any vaccines you’re missing can typically be administered at the civil surgeon’s office or by your primary care doctor, though you’ll need to return to the civil surgeon to have the completed record documented on your Form I-693. Missing records for childhood vaccines sometimes mean getting revaccinated, since the civil surgeon needs documented proof.
How Long the Results Stay Valid
For any Form I-693 signed by a civil surgeon on or after November 1, 2023, the results are valid only while the application they were submitted with is pending. If your application is withdrawn or denied, the Form I-693 tied to it is no longer valid. This is a change from earlier policies that allowed the form to remain valid for a set period regardless of the application’s status.
Cost and Insurance Coverage
USCIS does not regulate what civil surgeons charge, so prices vary widely. The total cost depends on your location, how many vaccinations you need, and whether additional testing (like a chest X-ray for a positive TB screening) is required. It is worth calling several civil surgeons in your area to compare fees before booking.
Many health insurance plans do not cover the immigration medical exam, and many civil surgeons do not accept insurance at all. Even when a civil surgeon does accept your plan, the insurer may not cover the vaccinations or lab work specific to immigration purposes. Ask about both the exam fee and any additional costs for labs and vaccines before your appointment so you’re not caught off guard.
How to Find a Civil Surgeon
USCIS maintains a searchable online tool at uscis.gov/tools/find-a-civil-surgeon where you can look up designated doctors by ZIP code. The tool lists contact information, so you can call ahead to confirm availability, fees, and what to bring. You are free to choose any designated civil surgeon in the country; you don’t have to pick one in the state where you live, though convenience usually makes a local option the practical choice.
When you call, ask whether the office handles the full exam in one visit or requires a follow-up. Some civil surgeons complete everything, including blood draws and vaccinations, on the same day. Others send you to an outside lab and schedule a second appointment to finalize the paperwork once results come back. Knowing this upfront helps you plan, especially if your adjustment of status application has a deadline approaching.