Medical Examination Requirements for Adjustment of Status - I-485
A medical examination is required for most I-485 (adjustment of status) applicants and requests for V nonimmigrant status (Form I-539). Medical examinations verify good health and admissibility to the U.S. on medical grounds. It can also identify medical conditions that require follow-up medical care after adjustment of status to permanent residence or immigration to the U.S.

The medical examination must be conducted by a USCIS designated civil surgeon. You can find one either by calling the National Customer Service Center at 1-800-375-5283 or online. They are licensed and experienced doctors who receive special and on-going immigration oriented medical training and policy updates. A medical examination performed by a doctor NOT approved by USCIS will not be recognized.

Results of the medical examination are reported in the Form I-693, Medical Examination of Aliens Seeking Adjustment of Status. Many civil surgeons have that form with them.

Results of the medical examination are valid for 1 year before you file I-485. After you file I-485, they are valid forever as long as I-485 is pending. Therefore, the medical examination can be done well in advance.

Medical examination is required to establish that you are not inadmissible to the United States on public health grounds. The results of your medical examination are confidential and are used for immigration purposes only. When required to do so by law, the civil surgeon may share your results with public health authorities.

Requirements
  • Adjustment of status applicants, immigrant visa applicants:
    They must undergo a medical exam including a vaccination assessment.
    Exception: Persons applying I-485 based on continuous residence since Jan 1, 1972 do not need to undergo a medical exam.

  • K and V nonimmigrant visa applicants:
    Individual applying for K visa or V visa (including those applying for V visa in the US) must undergo a medical exam, but are not required to comply with vaccination requirements at that time.
    However, when they apply for adjustment of status later, they will have to comply with vaccination requirements. No medical exam is necessary again as long as they apply for adjustment of status within 1 year of previous medical exam.

  • Refugees:
    Individuals outside of the U.S. applying for admission as refugees must undergo a medical exam, but they are not required to comply with the vaccination requirements at that time.

  • Refugee adjustment applicants:
    They will not be required to repeat the medical exam they had overseas, unless a medical ground of inadmissibility was discovered. But the applicant must still comply with the vaccination requirements and submit the vaccination sign-off. Contact your state refugee health coordinator or local refugee resettlement agency to find out whether it is possible for you to have the vaccination sign-off done by a state or local health department.

  • Asylees:
    Individuals already in the U.S. who are applying for asylum are not required to undergo a medical exam.

  • Asylee adjustment applicants:
    Asylees need to undergo medical exam, including the vaccination assessment, just like any other adjustment of status applicant.
    However, Form I693 should not be filed with the initial asylum-based I-485 application. This information will be requested at the time of adjudication.

Note: A medical exam is not required for other nonimmigrant visa applicants and nonimmigrants arriving at a port of entry, but the consular officer overseas or the inspector at the port of entry can require you to undergo an exam if there are reasons to believe that you might be inadmissible on medical grounds.

Examination Details
The designated civil surgeon or panel physician must perform these tests in accordance with the Technical Instructions for the Medical Examination of Aliens in the United States, published by the Centers for Disease Control and Prevention (CDC).

When you go to your medical examination appointment, you need to carry your passport, or other form of government issued photo identification, and any written documentation of your vaccination history. For applicants under 14 years, you can take other proof of identity that shows name, date and place of birth, parents' full names, and any other identifying information about the applicant. Acceptable documents include birth certificates (with translations, if necessary) or affidavits.

No photographs are required in the U.S. Three photographs are required outside the U.S.

Following components are required in the medical examination:
  • Physical Examination: Required for all of ALL applicants, regardless of age. Physical examination consists of checking your general health like blood pressure, eyes, ears, hitting a small hammer on knees and elbows. You also have to drop your pants for the doctor to check the health of your genital organs. A mental status evaluation is required as well.

  • Tuberculin (TB) Skin Test: All applicants age 2 and older are required to have a tuberculin skin test (TST). Applicants under the age of 2 years may be required to have a tuberculin skin test if tuberculosis (TB) is suspected or if the applicant has a history of contact with a known TB case, or if there is any other reason to suspect TB.

    After the skin test, you will have to return to the civil surgeon within 2-3 days to have the results read. If you have a reaction of 4 mm or less, you won't need any further tests for TB, unless you have signs or symptoms of TB or immunosupression. A chest X-ray is required for all applicants when the reaction to the TST is 5 mm or more, including pregnant women.

    If the doctor thinks you are infected with tuberculosis, you may have to go to the local health department and more tests may have to be done.

    Applicants with Class A tuberculosis must complete a full course of TB treatment before receiving medical clearance by USCIS for adjustment of status.

    Sputum cultures and drug susceptibility testing for positive cultures are required for applicants with chest x-ray findings suggestive of active TB disease.

    Unless one of the exceptions listed in the Technical instructions apply, the designated physician must administer the TST and can not just perform a chest x-ray directly. If it is done that way, an acceptable reason for omitting the TST must be noted on Form I-693.

  • Serologic (Blood) Test: Applicants 15 years of age and older are required to have serologic (blood) tests for HIV (virus that causes AIDS, Acquired Immuno Deficiency Syndrome) and for syphilis. Civil surgeon or panel physician can require applicants under age 15 to be tested for HIV or syphilis if there is reason to suspect the possibility of infection. Civil surgeons are required to provide pre-test counseling to all applicants who take the HIV test. If you are found to have HIV infection, the civil surgeon must provide you with post-test counseling.

  • Vaccinations: Please refer to detailed vaccination requirements.

USCIS does not charge a fee for the submittal of Form I-693. However, you are responsible for paying all doctor and laboratory fees for the medical examination. Your insurance will not pay for it either. Depending upon the area you are located in, it may cost several hundred dollars.

After the medical examination is complete, sign form I-693 in the presence of the civil surgeon. The civil surgeon will certify the results on the appropriate forms (I-693 for medical exam and vaccination supplement form) including chest X-ray report if a chest X-ray examination was performed and place them in a sealed envelope. DO NOT OPEN THE SEALED ENVELOPE. Submit the envelope with your immigration application. USCIS may share the results of your examination with health departments and other public health or cooperating medical authorities.

Expect laboratory tests results in two to three days.

If you need more tests because of a condition found during your medical examination, the doctor may send you to your own doctor or to the local public health department. For some conditions, before you can become a temporary or permanent resident, you will have to show that you have followed the doctor's advice to get more tests or take treatment.

When a chest x-ray is required, a full and formal radiologist's chest x-ray report, whether a copy or an original, signed by the radiologist and on official hospital or medical office letterhead must be submitted in the sealed envelope. Any preliminary or incomplete evaluation, whether handwritten or not, that does not describe the full evaluation of findings, is not acceptable. In most cases, the civil surgeon will have to wait a day or two before this report has been sent by the reviewing medical office and can therefore not sign off on the Form I-693 until this report has been received.

More information on Medical Examinations from CDC.

Pregnancy
There are many immigration applicants who are either trying for pregnancy or the wife is already pregnant. A chest x-ray is required for all applicants with a TST reaction of more than 5 mm after a TB test, including pregnant women. If a chest-ray is not recommend by a doctor for pregnant woman, such applicant would just have to wait until it is safe again to take a chest x-ray.
Also vaccines like MMR can't be given. This applies to both husband and wife. The doctor would just give the allowed vaccines and may ask the expecting mother to take other vaccines after the baby is delivered. They will most likely give vaccines like tetanus, DPT only after consulting the wife's gynecologist. Also vaccines like Polio would not be necessary for adults as it would not be the appropriate age to give that vaccine. The doctor might also want to get the results from the person's gynecologist tests such as blood work etc., so that they wouldn't be necessary again.

Medical Grounds of Inadmissibility
When an applicant has a health condition which is a public health concern to the United States, he/she may not get immigration benefit on "Medical grounds of inadmissibility".

They are divided into 4 categories:
  • communicable disease of public health significance;
    It is defined in the HHS regulations and includes the following 9 infectious medical conditions:
    • severe acute respiratory syndrome (SARS)

    • tuberculosis (TB)

    • leprosy

    • human immunodeficiency virus (HIV/AIDS)
      If you were tested positive for the HIV, you may be able to file a waiver application. You must also show that your admission into the U.S.:
      • Poses minimal public health danger

      • Holds minimal possibility of spread of infection

      • Will not incur costs to any government agency without prior consent from that agency.

      Note: Individuals seeking admission as refugees from outside the United States are not required to submit documentation of individual eligibility for HIV treatment or health care coverage with Form I-602. They are already considered to have the required consent based on their eligibility for Federally funded programs and the assurances provided to USCIS by HHS.

    • syphilis (infectious state)

    • cancroids (STD, similar to syphilis and herpes)

    • gonorrhea

    • granuloma inguinale (STD, donovanosis)

    • lymphogranuloma (STD, chlamydia)

    Most communicable diseases are easily treatable. If the medical tests are positive for a communicable disease, the doctor will recommend a course of treatment. Some medical conditions are not easily treatable. However, you may still receive an immigration benefit by filing a waiver application.

  • lack of required vaccinations (for immigrant visa applicants only);

  • physical or mental disorders with harmful behavior; and
    Not all physical or mental disorders are considered "medical grounds of ineligibility". The civil surgeon or panel physician must determine that there is no harmful behavior, that is likely to recur, associated with the disorder in question.

    If you have a physical or mental condition with associated harmful behavior, you may still be eligible for an immigration benefit. You may apply for a waiver according to the terms and conditions established by USCIS, in consultation with CDC.

  • drug abuse/drug addiction.
    Using the CDC guidelines, Civil Surgeons and Panel Physicians review the applicant's medical history during the medical exam and ask questions considered necessary to determine whether or not there is any current or past use of any drugs or other psychoactive substances (other than strictly experimental). Applicants may also be required to undergo additional testing for substance abuse.

    If the Panel Physician or Civil Surgeon finds that you have a history of drug use or drug addiction, he or she will discuss the medical treatment options.

    There is no waiver available for this condition for most adjustment of status applicants.
    If you are applying for admission as a refugee, or for adjustment of status at least 1 year following your initial admission as a refugee or the grant of asylum, you may be granted a waiver for humanitarian reasons, to assure family unity, or when it is otherwise in the public interest.
    File Form I-602, Application by Refugee for Waiver of Ground of Excludability, with no fee.

Discovering a health problem during the medical exam:
If a health condition is diagnosed which makes you inadmissible, you may still be eligible for immigration after completing treatment for the condition. In some cases, you may still be eligible for immigration after applying for a waiver to overcome the medical ground of inadmissibility.

If you have medical problems like heart disease, high blood pressure, diabetes, depression, or chronic medical problems such as asthma, that is generally not the problem. The primary problem that is being looked at would be infectious diseases that are a public health threat, such as HIV/AIDS and active TB or whether the immigrant is a danger to himself or others such as uncontrolled mental illness. The primary concern is whether the applicant has a medical problem that might cause him/her to be debilitated and institutionalized, unable to work, a threat to others, and being so debilitated that someone would have to provide care of the immigrant.

If you have a chronic medical problem that concerns you whether you pass the exam, it is advisable to obtain copies of your medical records and bring them to your medical exam. Additionally, obtain a letter signed by your doctor, attesting the stability of your medical problem, and that you were being successfully treated.

If you have a history of drug abuse, obtain a letter from a doctor or counselor indicating the time period you have been drug-free, take a drug test in advance and bring the results with you to the exam.

Medical Waiver
A medical waiver permits an immigration applicant to be allowed into, or remain in the US despite having a health condition identified as medical grounds of inadmissibility. The waiver may be granted according to the terms and conditions (which can include posting a bond) determined necessary by USCIS in consultation with public health officials, based on the nature of the medical condition.

You are eligible for a waiver if:
  • You are the spouse or an unmarried son or daughter or the minor, unmarried adopted child of a US citizen or lawful permanent resident; or

  • You have a son or daughter or lawfully adopted child who is a US citizen or LPR (lawful permanent resident); or

  • You are eligible for classification as a self-petitioning spouse or child (including your derivative children) because of abuse.

Application
  • Adjustment of status applicant:
    File Form I-601, Application for Waiver of Grounds of Excludability, including payment of fee, with the USCIS office where you filed your adjustment of status application.

  • Immigrant visa at a U.S. consular post abroad:
    Submit your waiver application to the consulate. The consulate will send your waiver application to the overseas USCIS office in that jurisdiction for a decision.

  • Refugee, Refugee's/Asylee's adjustment of status:
    If you are applying for admission as a refugee, or for adjustment of status at least 1 year following your initial admission as a refugee or the grant of asylum, you may be granted a waiver for humanitarian reasons, to assure family unity, or when it is otherwise in the public interest.
    File Form I-602, Application by Refugee for Waiver of Ground of Excludability, with no fee.