USCIS · Official form

Form I-693, Report of Immigration Medical Examination and Vaccination Record

Form I-693 records the medical examination that most green card applicants in the United States must complete with a USCIS-designated civil surgeon. Fill in the applicant portion of the official PDF below and download it.

Fill out I-693 in the editor Download the blank PDF Quick fill on this page

This is the genuine USCIS PDF, unmodified. Source: USCIS official page.

What is I-693?

Form I-693, Report of Immigration Medical Examination and Vaccination Record, documents the results of the immigration medical exam required for most applicants adjusting status in the United States. It shows whether the applicant has a health-related condition that would make them inadmissible, and records the required vaccinations.

The applicant completes only the personal information section. Everything else is completed and signed by a civil surgeon, a doctor specifically designated by USCIS for these exams. After the exam, the civil surgeon seals the completed form in an envelope, and USCIS will not accept it if the envelope has been opened. Most applicants submit it with Form I-485 or bring it to an interview; check the current USCIS guidance on when to submit it and how long a signed form remains valid.

Who files I-693?

Applicants filing Form I-485 to adjust status to permanent resident inside the United States
Refugees and asylees adjusting status, who may need a full exam or only the vaccination portion
Other applicants USCIS directs to complete a medical exam, such as certain V status and registry applicants
The exam itself is performed and certified by a USCIS-designated civil surgeon, not the applicant

How to fill out I-693

Find a USCIS-designated civil surgeon near you using the locator tool at uscis.gov and schedule the exam.
Complete the applicant information section of the form and bring identification, your vaccination records, and any medical history to the appointment.
The civil surgeon performs the exam, orders any required tests, records vaccinations, and completes and signs the rest of the form.
Receive the completed form in a sealed envelope; keep a copy for your records but do not open the sealed original.
Submit the sealed envelope to USCIS with your Form I-485 package, in response to a request for evidence, or at your interview, as the current instructions direct.

Worth knowing: The applicant fills out only the personal information section. The exam, test results, vaccination record, and signature must come from a USCIS-designated civil surgeon, and the form must be submitted in the sealed envelope the civil surgeon provides.

Quick fill I-693 on this page

Prefer to see the form itself while you type? Open I-693 in the editor to fill it on the actual pages, add a signature, and download.

These are the form's own fields, in the order they appear on the pages. Fill in what you know; anything left blank stays a fillable field in the PDF, so you can finish it in any PDF reader. Nothing you type here is sent to USCIS.

Page 1 23 fields

Part 1. Information About You (To be completed by the person requesting a medical examination, NOT the civil surgeon). 1. Your Full Legal

Part 1. Information About You (To be completed by the person requesting a medical examination, NOT the civil surgeon). 2. Current Physical

Part 1. Information About You (To be completed by the person requesting a medical examination, NOT the civil surgeon). 2. Physical Address.

Part 1. Information About You (To be completed by the person requesting a medical examination, NOT the civil surgeon). 2. Current Physical

Part 1. Information About You (To be completed by the person requesting a medical examination, NOT the civil surgeon). 3. Other

Part 1. Information About You (To be completed by the person requesting a medical examination, NOT the civil surgeon). 2. Current Physical

Part 1. Information About You (To be completed by the person requesting a medical examination, NOT the civil surgeon.) 4. Immigration

Page 2 10 fields

Part 2. Applicant's Statement, Contact Information, Certification, and Signature. Applicant's Signature. NOTE: Do not sign or date Form I-6

Part 3. Interpreter's Contact Information, Certification, and Signature. Interpreter's Full Name. 1. Enter Interpreter's Given Name (First

Part 3. Interpreter's Contact Information, Certification, and Signature. If you used anyone as an interpreter to read the Instructions and

Part 3. Interpreter's Contact Information, Certification, and Signature. Interpreter's Full Name. 2. Enter Interpreter's Business or

Part 3. Interpreter's Contact Information, Certification, and Signature. Interpreter's Contact Information. 4. Enter Interpreter's Mobile

Part 3. Interpreter's Contact Information, Certification, and Signature. Interpreter's Contact Information. 3. Enter Interpreter's Daytime

Part 3. Interpreter's Contact Information, Certification, and Signature. Interpreter's Contact Information. 5. Enter Interpreter's Email

Part 2. Applicant's Statement, Contact Information, Certification, and Signature. Applicant's Contact Information. Provide your daytime

Page 3 11 fields

Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's

Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Provide the

Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's

Part 3. Interpreter's Contact Information, Certification, and Signature. Interpreter's Certification. I certify, under penalty of perjury,

Part 3. Interpreter's Contact Information, Certification, and Signature. Interpreter's Signature. 6. Enter Date of Signature. Enter as 2

Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant. Preparer's

Part 5. Applicant's Identification Information. Please complete the following about the applicant: 2. Enter Document Identification Number

Part 5. Applicant's Identification Information. Please complete the following about the applicant: 1. Enter Form of identification

Page 4 31 fields

Part 7. Civil Surgeon's Contact Information, Certification, and Signature. Civil Surgeon's Information. 1. Enter Given Name (First Name).

Part 7. Civil Surgeon's Contact Information, Certification, and Signature. NOTE: Do not sign Form I-6 93 and do not have the applicant sign

Part 7. Civil Surgeon's Contact Information, Certification, and Signature. Civil Surgeon's Information. 2. Enter Name of Medical Practice,

Part 7. Civil Surgeon's Contact Information, Certification, and Signature. Civil Surgeon's Information. 1. Enter Middle Name, if applicable.

Part 7. Civil Surgeon's Contact Information, Certification, and Signature. Civil Surgeon's Information. 1. Enter Civil Surgeon

Part 6. Summary of Medical Examination (To be completed by the civil surgeon). 3. Dates of Follow-up Examinations, if required. Enter Date

Part 6. Summary of Medical Examination (To be completed by the civil surgeon). 2. Enter Date of First Examination (Date applicant signed in

Part 6. Summary of Medical Examination (To be completed by the civil surgeon). 1. Summary of Overall Findings. B. Select Class B Conditions

Part 6. Summary of Medical Examination (To be completed by the civil surgeon). 1. Summary of Overall Findings. A. Select No Class A. or

Part 6. Summary of Medical Examination (To be completed by the civil surgeon). 1. Summary of Overall Findings. C. Select Class A.

Part 7. Civil Surgeon's Contact Information, Certification, and Signature. Physical Address. 3. Enter Street Number and Name.

Part 7. Civil Surgeon's Contact Information, Certification, and Signature. Physical Address. 3. Enter Apartment, Suite or Floor Number.

Part 7. Civil Surgeon's Contact Information, Certification, and Signature. Physical Address. 3. Select Floor.

Part 7. Civil Surgeon's Contact Information, Certification, and Signature. Physical Address. 3. Select Suite.

Part 7. Civil Surgeon's Contact Information, Certification, and Signature. Physical Address. 3. Select Apartment.

Part 7. Civil Surgeon's Contact Information, Certification, and Signature. Physical Address. 3. Enter City or Town.

Part 7. Civil Surgeon's Contact Information, Certification, and Signature. Physical Address. 3. Select State from List of States.

Part 7. Civil Surgeon's Contact Information, Certification, and Signature. Physical Address. 3. Enter ZIP Code.

Part 7. Civil Surgeon's Contact Information, Certification, and Signature. Mailing Address. 4. Enter Street Number and Name Street Number

Part 7. Civil Surgeon's Contact Information, Certification, and Signature. Mailing Address. 4. Enter Apartment, Suite or Floor Number, if

Part 7. Civil Surgeon's Contact Information, Certification, and Signature. Mailing Address. 4. Select Floor.

Part 7. Civil Surgeon's Contact Information, Certification, and Signature. Mailing Address. 4. Select Suite.

Part 7. Civil Surgeon's Contact Information, Certification, and Signature. Mailing Address. 4. Select Apartment.

Part 7. Civil Surgeon's Contact Information, Certification, and Signature. Mailing Address. 4. Enter City or Town.

Part 7. Civil Surgeon's Contact Information, Certification, and Signature. Mailing Address. 4. Select State from List of States.

Part 7. Civil Surgeon's Contact Information, Certification, and Signature. Mailing Address. 4. Enter ZIP Code.

Part 7. Civil Surgeon's Contact Information, Certification, and Signature. Contact Information. 6. Enter Mobile Telephone Number, if any.

Part 7. Civil Surgeon's Contact Information, Certification, and Signature. Contact Information. 5. Enter Daytime Telephone Number.

Part 7. Civil Surgeon's Contact Information, Certification, and Signature. Contact Information. 7. Enter Email Address, if any.

Page 5 1 fields

Part 7. Civil Surgeon's Contact Information, Certification, and Signature. Civil Surgeon's Signature. 8. Enter Date of Signature. Enter as

Page 6 28 fields

Page 7 47 fields

Page 8 29 fields

Page 9 10 fields

Part 8. Civil Surgeon Worksheet. 1. Communicable Disease of Public Health Significance. D. Other Class A. / Class B Conditions for

Part 8. Civil Surgeon Worksheet. 2. Physical or Mental Disorders With Associated Harmful Behavior. Include here any physical or mental

Part 8. Civil Surgeon Worksheet. 1. Communicable Disease of Public Health Significance. D. Other Class A. / Class B Conditions for

Part 8. Civil Surgeon Worksheet. 2. Physical or Mental Disorders With Associated Harmful Behavior. Include here any physical or mental

Page 10 6 fields

Part 8. Civil Surgeon Worksheet. 3. Drug Abuse / Drug Addiction. The U.S. Department of Health and Human Services (DHHS) sets the medical

Part 8. Civil Surgeon Worksheet. 4. Other Medical Conditions (List any other Class B conditions, such as hypertension or diabetes, and all

Part 8. Civil Surgeon Worksheet. 3. Drug Abuse / Drug Addiction. The U.S. Department of Health and Human Services (DHHS) sets the medical

Page 11 26 fields

Part 9. Referral Evaluation (To be completed by the health department or other doctor performing the referral evaluation). 3. Signature of

Part 9. Referral Evaluation (To be completed by the health department or other doctor performing the referral evaluation). 4. Enter Name of

Part 9. Referral Evaluation (To be completed by the health department or other doctor performing the referral evaluation). 2. Address.

Part 9. Referral Evaluation (To be completed by the health department or other doctor performing the referral evaluation). 5. Enter Daytime

Part 9. Referral Evaluation (To be completed by the health department or other doctor performing the referral evaluation). 1. Evaluating

Part 9. Referral Evaluation (To be completed by the health department or other doctor performing the referral evaluation). The applicant

Part 9. Referral Evaluation (To be completed by the health department or other doctor performing the referral evaluation). 1. Evaluating

Part 8. Civil Surgeon Worksheet. 5. Required Referral to Health Department or Other Doctor (To be completed by civil surgeon, if referral

Part 8. Civil Surgeon Worksheet. 5. Required Referral to Health Department or Other Doctor (To be completed by civil surgeon, if a referral

Part 8. Civil Surgeon Worksheet. 5. Required Referral to Health Department or Other Doctor (To be completed by civil surgeon, if referral

Page 12 126 fields

Page 13 4 fields

Part 10. Vaccination Record. Results. Select Applicant completed vaccination requirements or may be eligible for blanket waivers as

Part 10. Vaccination Record. Results. Select Applicant does not meet immunization requirements.

Part 10. Vaccination Record. Results. Select Applicant will request an individual waiver based on religious or moral convictions.

Part 10. Vaccination Record. Enter Remarks. If needed, provide any comments, such as the reason for contraindication.

Page 14 16 fields

Part 11. Additional Information. 5. D. Enter Additional Information.

Part 11. Additional Information. 3. A. Enter Page Number.

Part 11. Additional Information. 3. B. Enter Part Number.

Part 11. Additional Information. 3. C. Enter Item Number.

Part 11. Additional Information. 3. D. Enter Additional Information.

Part 11. Additional Information. 6. A. Enter Page Number.

Part 11. Additional Information. 6. B. Enter Part Number.

Part 11. Additional Information. 6. C. Enter Item Number.

Part 11. Additional Information. 6. D. Enter Additional Information.

Part 11. Additional Information. 5. C. Enter Item Number.

Part 11. Additional Information. 5. B. Enter Part Number.

Part 11. Additional Information. 5. A. Enter Page Number.

Part 11. Additional Information. 4. A. Enter Page Number.

Part 11. Additional Information. 4. B. Enter Part Number.

Part 11. Additional Information. 4. C. Enter Item Number.

Part 11. Additional Information. 4. D. Enter Additional Information.

Lock the PDF after filling (values become permanent, fields are removed)

Processed on our own servers, never sent to a third-party service. Files are deleted automatically after two hours, and you can delete them sooner from the result screen.

Frequently asked questions

Can any doctor complete Form I-693?

No. Only a civil surgeon designated by USCIS can perform the exam and sign the form for adjustment applicants in the United States. Exams done abroad for immigrant visas use panel physicians under Department of State procedures instead.

What happens if I open the sealed envelope?

USCIS will reject the form. The civil surgeon must give you the completed form in a sealed envelope, and it must reach USCIS unopened. Ask the civil surgeon for a separate copy for your own records.

How long is a completed Form I-693 valid?

Validity rules have changed several times, and USCIS policy on when a signed form remains usable is updated periodically. Check the current I-693 guidance at uscis.gov before relying on an exam completed some time ago.

Form I-693, Report of Immigration Medical Examination and Vaccination Record

What is I-693?

Who files I-693?

How to fill out I-693

Quick fill I-693 on this page

Frequently asked questions

Related forms

Form I-485, Application to Register Permanent Residence or Adjust Status

Form I-765, Application for Employment Authorization

Form I-131, Application for Travel Document