Form I-693 Medical Examination in 2026: A Civil Surgeon Guide for Massachusetts Green Card Applicants

Why Form I-693 Matters More Than Ever in 2026

If you are filing for adjustment of status in 2026, Form I-693, Report of Immigration Medical Examination and Vaccination Record, is no longer a paperwork step you can put off. In two short years, three back-to-back policy shifts have moved Form I-693 from a quiet item on the I-485 checklist to a critical filing component that can get an entire green card application rejected.

On December 2, 2024, USCIS made Form I-693 a required, concurrent filing with Form I-485. On April 4, 2024, USCIS first announced that a Form I-693 signed on or after November 1, 2023 would be valid indefinitely. Then on June 11, 2025, USCIS reversed that policy and tied the form's validity to the life of the application it was submitted with. In January and March of 2025, the COVID-19 vaccination requirement was removed for both adjustment of status applicants and overseas immigrant visa applicants. And on May 6, 2026, USCIS published a new edition of the Form G-1055 Fee Schedule that confirms there is still no USCIS filing fee for Form I-693 itself.

This guide walks Massachusetts families through what Form I-693 is, who must file it, what the civil surgeon does at your appointment, which vaccinations are still required, which medical conditions can make you inadmissible, what Class A and Class B findings mean, when you need a Form I-601 waiver, and how to use the USCIS Find a Civil Surgeon tool to locate a designated physician in Boston, Brockton, Framingham, Lowell, Marlborough, Mattapan, Milford, Randolph, Stoughton, and Worcester.

What Is Form I-693?

Form I-693 is the official record of your immigration medical examination. Its function is narrow but important. It documents whether you have any of the four health-related grounds of inadmissibility under INA 212(a)(1), and whether you have received the vaccinations required by the Centers for Disease Control and Prevention for immigration purposes. USCIS uses it to confirm that you are not inadmissible on health grounds before issuing your green card.

Form I-693 is not a general physical, an employment physical, or an insurance physical. The exam is limited to what immigration law requires. Only a USCIS-designated civil surgeon, a blanket-designated state or local health department physician for refugees, or a blanket-designated military physician for service members may complete the form. A family doctor who is not designated cannot sign Form I-693, no matter how thorough their exam.

Who Has to File Form I-693

Most applicants seeking adjustment of status to lawful permanent resident must file Form I-693 with their Form I-485. This includes the following common categories of applicants in Massachusetts:

• Family-based applicants filing I-485 based on an approved I-130, including marriage-based green card cases
• Employment-based applicants filing I-485 based on an approved I-140
• VAWA self-petitioners filing I-485 based on an approved I-360
• SIJS recipients filing I-485 based on an approved I-360 once a visa number is available under the EB-4 preference
• U-Visa principal applicants who have completed the three years required for I-485 adjustment under INA 245(m)
• T-Visa holders filing for adjustment under INA 245(l)
• Asylees and refugees filing for adjustment one year after the grant of asylum or admission as a refugee
• Diversity Visa lottery winners filing for adjustment in the United States

Refugees in particular have a partial exemption. A refugee who completed an overseas medical examination is generally only required to update the vaccination portion of Form I-693 when applying for adjustment, not the entire medical record.

The December 2, 2024 Concurrent Filing Rule

Before December 2, 2024, applicants commonly filed Form I-485 without Form I-693 and later mailed in the medical examination, either in response to a USCIS Request for Evidence or in the days leading up to the adjustment interview. That practice ended.

USCIS announced on December 2, 2024 that applicants must now file Form I-693 concurrently with Form I-485. The USCIS alert states that without a properly completed Form I-693 in the initial filing package, USCIS may reject the Form I-485 outright. A rejection is not a denial: the entire package is returned, no priority date is preserved on a fee-based filing, and the applicant must refile from scratch with a current medical exam. For a marriage-based or VAWA-based applicant who is racing against an underlying status expiration, an avoidable rejection can be devastating.

This rule applies regardless of whether you file on paper or online. As of February 10, 2025, USCIS only accepts the 10/24/24 edition of Form I-485. Make sure your civil surgeon is using a current edition of Form I-693 as well. If the civil surgeon signs your Form I-693 on July 3, 2025 or later, USCIS will only accept the 01/20/25 edition.

The June 11, 2025 Validity Reversal

For a brief period, Form I-693 was effectively a lifetime document. On April 4, 2024, USCIS updated Volume 8 of the Policy Manual to provide that a Form I-693 properly signed by a civil surgeon on or after November 1, 2023 was valid indefinitely. Prior policy had limited the form's usefulness to a two-year window from the date of signature.

On June 11, 2025, USCIS reversed course. The updated guidance, effective immediately and applicable to applications pending or filed on or after that date, provides that a Form I-693 signed on or after November 1, 2023 is valid only while the application it was filed with remains pending. USCIS explained that the prior indefinite validity policy was overly broad and could pose a public health risk.

For applicants, the practical effect is that you cannot recycle a Form I-693 from a withdrawn or denied application onto a fresh I-485. The form is anchored to a specific filing. If a prior I-485 was denied, withdrawn, or rejected, plan on a fresh medical examination for any new filing. If your I-485 has been pending for years, the medical examination filed with it generally remains valid for the life of that case without needing to be redone, as long as it was properly signed on or after November 1, 2023.

What Happens at the Civil Surgeon Appointment

The immigration medical examination has a fixed scope. Civil surgeons follow the CDC Technical Instructions for Civil Surgeons, which set out what must be tested and documented. A standard appointment for an adult applicant usually includes:

Medical History Review

The civil surgeon will ask about past hospitalizations, surgeries, psychiatric history, history of drug or alcohol use, and any current medications. Bring a list of all current medications, names of physicians you have seen recently, and any records you have of prior tuberculosis treatment, hepatitis treatment, or psychiatric care. Be honest. Lying to a civil surgeon can support a finding of misrepresentation under INA 212(a)(6)(C) and create a separate, more serious admissibility problem.

Physical Examination

A general physical exam covering eyes, ears, nose, throat, lungs, heart, abdomen, lymph nodes, extremities, skin, and a brief neurological check.

Tuberculosis Screening

All applicants 2 years of age and older must complete an Interferon-Gamma Release Assay, or IGRA, blood test. The CDC currently approves only the QIAGEN QuantiFERON and the Oxford Immunotec T-SPOT.TB IGRA products. The test, the laboratory that ran it, and the result must be documented in Part 8 of Form I-693, even if the result is negative or indeterminate. If the IGRA result is positive, the civil surgeon will order a chest X-ray and, depending on findings, further evaluation. For children under 2, screening rules differ and the civil surgeon will follow the CDC Technical Instructions.

Syphilis and Gonorrhea Testing

Syphilis serology is required for applicants 18 and older, and for younger applicants on a case-by-case basis. Gonorrhea testing is required for applicants 18 to 24 years old. Both tests are part of the standard appointment and do not require separate scheduling.

Vaccination Review and Administration

Bring every vaccination record you have. If you can secure your childhood records from your home country, your school records from Brazil, Haiti, or Cabo Verde, or your prior records from any U.S. provider, bring them. The civil surgeon will record verifiable doses on Form I-693 and administer any missing vaccinations required for your age.

Sealed Envelope or Online Upload

The civil surgeon must give you the completed Form I-693 in a sealed envelope with their signature across the seal. If you are filing Form I-485 by mail, include the still-sealed envelope in your filing package. If you are filing Form I-485 online, open the envelope yourself and upload the form. In either case, keep the original Form I-693 and the original envelope until USCIS issues a final decision on your I-485. USCIS may ask to inspect them at your interview.

Required Vaccinations in 2026

The CDC sets the list of required immigration vaccines, and the list reflects vaccine-preventable diseases for which a vaccine is age-appropriate, medically appropriate, and available in the United States. For 2026, the age-appropriate vaccinations include:

• Measles, Mumps, and Rubella (MMR)
• Polio
• Tetanus, Diphtheria, and Pertussis (Tdap or Td)
• Pertussis
• Haemophilus influenzae type B (Hib)
• Hepatitis A
• Hepatitis B
• Rotavirus
• Meningococcal disease
• Varicella (chickenpox)
• Pneumococcal disease
• Seasonal influenza (during flu season)

The civil surgeon will administer only those vaccinations that are age-appropriate and not contraindicated for you. You do not need every vaccine on the list. A 45-year-old applicant, for example, will not need rotavirus vaccine, which is for infants. A pregnant applicant will not receive vaccines contraindicated during pregnancy.

Class A and Class B Findings: What They Mean

The civil surgeon may classify any abnormal finding on your exam into one of two boxes, and the difference is enormous.

Class A: You Are Inadmissible Unless You Cure or Waive

A Class A finding means the civil surgeon has identified a condition that makes you inadmissible to the United States under INA 212(a)(1). USCIS Policy Manual Volume 8, Part B groups Class A findings into four categories:

• Communicable disease of public health significance. The current list at 42 CFR 34.2 includes active tuberculosis, infectious syphilis, gonorrhea, and Hansen's disease (leprosy, infectious form), plus any disease designated by Presidential Executive Order as quarantinable and any disease that meets the World Health Organization criteria for a public health emergency of international concern. Chancroid, granuloma inguinale, and lymphogranuloma venereum were removed from the list by HHS final rule effective March 28, 2016. The list is set by the Department of Health and Human Services, not USCIS, and any HHS update controls.
• Failure to present documentation of having received required vaccinations against vaccine-preventable diseases
• A current or past physical or mental disorder with associated harmful behavior, where the harmful behavior either has caused harm to the applicant or others or is likely to recur
• Drug abuse or drug addiction, defined by reference to substances listed in the Controlled Substances Act

Some Class A conditions can be cured before adjudication. Active syphilis treated with antibiotics, for example, can move a finding from Class A to Class B in a relatively short period. Active tuberculosis treated under directly observed therapy can do the same once the patient is no longer infectious. Missing vaccinations can be cured by getting the vaccination, by obtaining a medical contraindication letter, or by filing a religious or moral conviction waiver under INA 212(g)(2)(C). Mental disorders with associated harmful behavior can sometimes be cured through documented treatment and remission.

Other Class A conditions require an I-601 waiver under INA 212(g), and a small subset are not waivable at all. Drug abuse and drug addiction have particularly strict standards and may require a 12-month period of remission documented by a mental health professional before USCIS will reclassify the finding. Speak with an immigration attorney before filing any I-485 that carries a Class A medical finding.

Class B: Worth Noting, But Not Disqualifying

A Class B finding is a physical or mental condition, disease, or disability that is serious in degree or permanent in nature, but does not render you inadmissible. Diabetes, hypertension, cancer in remission, depression in remission, and a history of treated tuberculosis are common Class B findings. USCIS will see the Class B finding on Form I-693, but it does not block approval of the green card.

The Form I-601 Waiver for Health-Related Inadmissibility

If you have a Class A finding that cannot be cured or that requires a waiver, the relevant filing is Form I-601, Application for Waiver of Grounds of Inadmissibility, citing INA 212(g) as the waiver authority. The standards are different for each ground:

• INA 212(g)(1) for certain communicable diseases such as tuberculosis. Available to spouses, parents, or unmarried sons and daughters of U.S. citizens or lawful permanent residents, and certain other categories. Discretionary.
• INA 212(g)(2)(B) for vaccinations that are not medically appropriate for you. Requires medical documentation that the vaccine would be harmful or that immunity is established by titer.
• INA 212(g)(2)(C) for vaccinations contrary to your religious belief or moral conviction. Three legal elements must be shown: the belief must be religious or moral, sincerely held, and opposed to all vaccinations in any form.
• INA 212(g)(3) for physical or mental disorders with associated harmful behavior. Discretionary, often supported by treating provider letters describing the treatment plan, prognosis, and risk of recurrence.

I-601 filings are document-heavy and benefit substantially from legal representation. The vaccine waiver for religious or moral conviction in particular is regularly denied where the applicant simply cites a personal preference, hesitancy, or general distrust of the medical system. The standard is a sincere, religious or moral, anti-vaccination belief.

Finding a Civil Surgeon in Massachusetts

Only a USCIS-designated civil surgeon may complete Form I-693 for an applicant filing in the United States. The official tool for locating one is the USCIS Find a Civil Surgeon page at uscis.gov/tools/find-a-civil-surgeon. Enter your address, city, or ZIP code, and the tool returns the names, addresses, and phone numbers of civil surgeons designated by USCIS in your area.

In the Greater Boston area, dozens of designated civil surgeons practice in Boston, Brookline, Cambridge, Somerville, Quincy, and along the I-93 and I-95 corridors. Civil surgeons are also designated in Brockton, Framingham, Lowell, Marlborough, Milford, Worcester, and Springfield. Massachusetts state and local boards of health have blanket civil surgeon designation for refugees who need the vaccination supplement only. Military physicians have blanket designation for service members, veterans, and their dependents when the examination is conducted on the premises of a Military Treatment Facility.

When you call to schedule, ask three questions before booking:

• What is the total cost of the immigration medical exam, and what does that include?
• Does the price include the IGRA tuberculosis blood test, syphilis serology, and required vaccinations, or are those billed separately?
• How quickly can you complete the sealed Form I-693, and which edition of the form do you currently use?

How Much Does the Medical Exam Cost?

There is no USCIS filing fee for Form I-693. The Form G-1055 Fee Schedule dated May 6, 2026 lists Form I-693 at zero dollars. The cost is what the civil surgeon charges, which is unregulated and varies. In Massachusetts, the typical range for an adult immigration medical exam is between 200 and 500 dollars before add-ons. Missing vaccinations, repeat tuberculosis screening, or follow-up chest X-rays can push the total higher.

The Form I-485 itself remains the dominant fee. The May 6, 2026 G-1055 Fee Schedule lists Form I-485 at 1,440 dollars by paper and 1,390 dollars when filed online for most applicants. Plan accordingly.

Frequently Asked Questions About Form I-693

Practical Steps Before You File

Before mailing or uploading your I-485 package, run through this checklist:

• Confirm the civil surgeon is currently USCIS-designated by cross-checking the Find a Civil Surgeon tool the week of your appointment
• Confirm the civil surgeon used the 01/20/25 edition of Form I-693
• Confirm the signature is an original wet signature, not a stamp or photocopy
• Confirm every relevant box on the form is completed, including the IGRA test result in Part 8
• Confirm the envelope is sealed and signed across the flap if you are filing by mail
• If filing online, open the envelope yourself and upload the form, then keep the original envelope and the original form for the interview
• If the form lists any Class A finding, do not file until you have spoken with an immigration attorney

For Brazilian, Haitian, Cape Verdean, and other immigrant families in Framingham, Brockton, Everett, Lowell, Marlborough, Mattapan, Milford, Randolph, Stoughton, and Greater Boston, the medical examination is one of the few I-485 components that has to be done in person, on a specific date, by a specific kind of doctor. Build it into your filing timeline from day one.