An immigration physical is a medical exam required by U.S. Citizenship and Immigration Services (USCIS) for anyone applying for a green card. Its purpose is to confirm that applicants are not inadmissible to the United States on health-related grounds. The results are documented on Form I-693, which you submit alongside your adjustment of status application.
Who Performs the Exam
You cannot use your regular doctor for this exam. If you’re inside the United States, a USCIS-designated civil surgeon must perform it. These are licensed physicians who have applied for and received a special designation from USCIS and follow technical instructions published by the CDC. The exam must be conducted in person; telemedicine is not allowed. If you’re applying from outside the U.S., a panel physician authorized by the Department of State performs the equivalent exam at a U.S. embassy or consulate.
You can search for a designated civil surgeon near you on the USCIS website.
What Happens During the Exam
The physical examination covers your eyes, ears, nose and throat, heart, lungs, abdomen, extremities, lymph nodes, and skin. The doctor also performs a mental status evaluation. The goal isn’t a comprehensive health workup. It’s a targeted screening for specific conditions that fall into four categories of medical inadmissibility: communicable diseases of public health significance, physical or mental disorders associated with harmful behavior, drug abuse or addiction, and failure to meet vaccination requirements.
The mental health portion assesses whether you have a diagnosed disorder that has caused or is causing serious injury to yourself or others, a threat to health or safety (such as driving while intoxicated), or major property damage. Substance use disorders are evaluated based on standard diagnostic criteria, and at least two of 11 clinical indicators must be present for a diagnosis.
TB Screening
Tuberculosis testing is one of the most involved parts of the exam. All applicants aged 2 and older must have a blood test called an interferon-gamma release assay, or IGRA. This replaces the older skin test method for immigration purposes. Only two FDA-approved blood tests are accepted.
A chest X-ray is required only if your blood test comes back positive, you have HIV, or you show signs or symptoms of TB. When an X-ray is needed, it must use digital radiography and be interpreted by a radiologist. Results must be available within three days.
Syphilis Testing
All applicants between 18 and 44 years old are tested for syphilis through a blood draw. Applicants younger than 18 or 45 and older are only tested if there’s a reason to suspect infection. Both a nontreponemal and a treponemal test are run on the same blood sample to confirm results.
Required Vaccinations
The vaccination review is often the most time-consuming part of the process, and the piece most likely to require a follow-up visit. The civil surgeon checks your records against the vaccines required by immigration law, which must be age-appropriate. The mandatory list includes:
- Measles, mumps, and rubella (MMR)
- Polio
- Tetanus, diphtheria, and pertussis (Tdap)
- Hepatitis B
- Haemophilus influenzae type B
- Any other vaccines currently recommended by the CDC’s Advisory Committee for Immunization Practices
As of May 2024, a single dose of the inactivated polio vaccine is required for anyone 2 months or older who cannot show proof of completing the childhood series. If your exam falls between September 1 and March 31, you’re also required to receive the seasonal flu vaccine. COVID-19 vaccination is no longer required as of January 20, 2025.
If you’re missing vaccinations, the civil surgeon can administer them during the appointment or you can get them elsewhere and return with documentation. Bring whatever immunization records you have, even partial ones, since proof of prior vaccination can reduce the number of shots you need.
What to Bring
USCIS doesn’t publish a rigid checklist, but you’ll need government-issued photo identification so the civil surgeon can verify your identity. Bring any vaccination records you have, whether from childhood, school, travel, or your home country. If you’ve had a previous TB test or chest X-ray, bring those results too. Having your records organized can save you from repeat testing and extra appointments.
How Long 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 green card application is denied or withdrawn, that Form I-693 is no longer valid. You would need a brand-new exam if you file again. This is a significant change from older rules that allowed results to remain valid for a set number of years regardless of the application’s outcome.
What Happens If Something Is Flagged
The civil surgeon classifies any findings as either Class A (conditions that make you inadmissible) or Class B (conditions that don’t block your application but are noted for the record). Communicable diseases like active TB and untreated syphilis fall into Class A, as do substance use disorders and mental health conditions tied to harmful behavior. Missing vaccinations are also a ground of inadmissibility, but that one is resolved simply by getting the shots.
A Class A finding doesn’t necessarily end your case. You can apply for a waiver of health-related inadmissibility under immigration law. The waiver process involves additional documentation and, depending on the condition, may require proof of treatment or evidence that you don’t pose a public health risk. An immigration attorney can help navigate this if it applies to your situation.
Cost and Practical Expectations
Immigration physicals are not covered by most insurance plans because they are considered an administrative requirement rather than a medical service. Costs vary widely by location and provider, typically ranging from a few hundred dollars to over $500, especially if you need multiple vaccinations or additional testing. Call ahead to confirm pricing, since the cost of lab work and vaccines is often billed separately from the exam fee.
The appointment itself usually takes 30 to 60 minutes, though you may need to return for a second visit if lab results are pending or if you need to complete a vaccine series. Plan to schedule your exam well before your USCIS interview or filing deadline, leaving a buffer for any follow-up visits.