US immigration medical examinations

The immigration medical examination is an important step in the immigration process and is mandatory for most green card applicants. The examination must be carried out by a government-authorised doctor (also known as a civil surgeon). During the immigration medical examination, the applicant can expect:

• A review of medical history and vaccination (immunisation) records
• A physical and mental assessment
• Drug and alcohol testing
• Testing for various diseases and health conditions (sometimes including an X-ray)

The purpose of the immigration medical examination is to ensure that the relative seeking agreen cardhas no health condition that would make them “inadmissible” to the United States — meaning that they would not be eligible for a green card.

Many green card applicants are anxious about this step in the process, and that is normal. The information we provide can help applicants avoid common mistakes in the immigration process.

Preparing thoroughly can make the whole examination less stressful and also helps applicants avoid any issues that could delay the green card application or cause it to be refused. Moreover, it is very rare to fail the immigration medical examination. And even where an applicant has a condition that could complicate the green card application, they can usually request a waiver.

To help applicants prepare, this guide covers everything applicants can expect at every stage of the immigration medical examination process.

Choosing the right doctor

Only 2 types of doctor may carry out an immigration medical examination, and the type appropriate to the applicant’s situation depends on where they are applying from:

1. Where the applicant is applying from within the United States, they see a civil surgeon designated byUnited States Citizenship and Immigration Services (USCIS).
2. Where the applicant is applying from abroad, they see apanel physicianauthorised by the US Department of State.

The cost of the immigration medical examination

The cost of the immigration medical examination varies considerably by location and provider. The amount payable is usually around USD 100 – USD 500, but USD 200 is typical. Unfortunately, there is no government funding for the immigration medical examination, so applicants must pay this cost themselves.

How to book the immigration medical examination

The process for scheduling the immigration medical examination depends on where the family member applying for the green card is applying from.

Where the applicant is applying from within the United States

• Timing of the booking: complete the immigration medical examination and submit the unopened examination report at the same time as the green card application.
• How to book:
  • Use the United States Citizenship and Immigration Services (USCIS) “find a doctor” tool.
  • Call the United States Citizenship and Immigration Services (USCIS) Contact Center at1-800-375-5283 (TTY: 1-800-767-1833) to find a nearby civil surgeon authorised to carry out the immigration medical examination. Tell the doctor’s office that the applicant is contacting them to book an immigration medical examination appointment.

Where the applicant is applying for a green card from abroad

• Timing of the bookingThe applicant may only schedule the immigration medical examination after receiving the green card interview appointment letter from theNational Visa Center (NVC), which is the part of the Department of State that processes green card applications for relatives living abroad. The Department of State expressly instructs family members seeking a green card from abroad not to schedule an immigration medical examination until they have been notified of the green card interview date.
• How to book: Well before receiving the appointment letter, look up the applicant’s US embassy or consulate, which provides instructions for the immigration medical examination, as well as contact details for authorised doctors in each country. The applicant needs to choose the doctor themselves (the National Visa Center (NVC) does not assign one to the applicant). Generally, it is best to book an appointment as soon as the interview appointment date is received from the National Visa Center (NVC).

When the applicant books the appointment, be sure to tell the doctor’s office that the applicant is seeking an immigration medical examination for the United States.

The examination results are valid for six months (unless the relative seeking the green card has certain medical conditions, in which case the results may expire in three months).

What documents to bring?

Having all the documents ready before the appointment can help the immigration medical examination go smoothly. Here is what the applicant needs to bring:

• Vaccination or immunisation records
• A copy of the medical history
• Copies of any previous chest X-ray films, where available
• A letter from the regular doctor outlining the treatment plan for any health issues the applicant has
• Government-issued photographic identification, such as a passport, state identity card, driving licence, travel permit, or work permit
• Payment for the immigration medical examination fee (check with the doctor’s office before the appointment about acceptable payment options)
• A health insurance card, where available (check with the doctor’s office before the appointment whether they accept the applicant’s insurance)

The applicant must also bring further documents, depending on where they are applying from:

Where the applicant is applying from within the United States

The applicant must also bring Form I-693 (officially called the “Report of Medical Examination and Vaccination Record”), on which the civil surgeon records the examination results.

Most doctors provide a copy of this form at their office. However, generally it is best to download Form I-693 from the United States Citizenship and Immigration Services (USCIS) website yourself (to ensure you are using the latest version) and bring it to the doctor’s office. United States Citizenship and Immigration Services (USCIS) updates these forms periodically, and some doctors forget to replace old copies with the current one.

Where the applicant submits an expired form, United States Citizenship and Immigration Services (USCIS) refuses it and requires the latest version of the form to be submitted, meaning a return to the doctor’s office and a delay in the application process.

To save time, it is best to complete the applicant’s section of the form before the appointment, but not to sign the form until the civil surgeon instructs you to do so. The civil surgeon completes their section of the form at the end of the examination.
There is no fee to file Form I-693, but the applicant must pay the medical examination fee.

Where the applicant is applying from abroad

The applicant must bring the green card interview appointment letter from the National Visa Center (NVC). The doctor will not carry out the medical examination unless the applicant arrives with this document, which they use to verify that the applicant has an active green card application.

During the immigration medical examination

The immigration medical examination is not the same as a routine check-up the applicant receives from a family doctor. Nor does the doctor give the applicant a “pass” or “fail” score based on overall health. (See below for important medical examination information for women.)

The examination lasts around 2 hours, and during that time the doctor reviews the vaccination and medical history with the applicant. They ask both general and specific questions about health. The applicant also has a basic examination (or “physical”).

The doctor also looks for specific conditions in the following categories (see below for information on how the presence of such conditions may affect the green card application):

• Communicable diseases (including tuberculosis, syphilis and gonorrhoea)
• Drug misuse or addiction
• Physical or mental disorders associated with harmful behaviour
• Conditions rendering the applicant unable to support themselves

To check for the conditions above, the doctor carries out several types of test:

Tuberculosis testing

Civil surgeons in the United States and panel physicians abroad follow different tuberculosis testing guidance from the Centers for Disease Control and Prevention (CDC):

Where the applicant is applying from within the United States

Civil surgeons follow the Centers for Disease Control and Prevention (CDC) Tuberculosis Technical Instructions for Civil Surgeons, which currently require them to carry out a test known as an “interferon-gamma release assay” (IGRA) on all green card applicants aged 2 and over. Generally, the applicant is not required to return to the doctor’s office for the IGRA results.

However, where the IGRA results reveal signs or symptoms of tuberculosis, the applicant is required to return to the clinic for a chest X-ray and to undergo further tests.

Where the applicant is applying from abroad

Panel physicians follow the Centers for Disease Control and Prevention (CDC) Tuberculosis Technical Instructions for Panel Physicians, which currently require all green card applicants aged 15 and over (in countries considered to have a “high tuberculosis burden”) to have a chest X-ray.
Where necessary, the applicant may be required to return to the clinic for further tests where the chest X-ray film and other related screening (a review of medical history and a physical examination) show signs and symptoms of tuberculosis.

It is also important to check the specific medical examination instructions from the US embassy or consulate, which may relate to tuberculosis testing.

Blood and urine tests

Doctors are required to carry out a blood test for syphilis and a urine test for gonorrhoea on all green card applicants aged 15 and over — whether applying from within the United States or from abroad.

Vaccination screening

Doctors are required to ensure that the applicant has received all the mandatory vaccines. Where the applicant is missing any, they are required to receive these before attending the green card interview, but the doctor should be able to provide these vaccines during the medical examination.

Drug and alcohol screening

The doctor asks questions about any prescription medicines the applicant takes, as well as past and current drug and alcohol use.

To find out more about the specific screening procedures for green card applicants, see the Centers for Disease Control and Prevention (CDC) guidance for civil surgeons (where the applicant is applying from within the United States) or its guidance for panel physicians (where the applicant is applying from abroad).

After the immigration medical examination

The civil surgeon asks the applicant to sign the form once the examination is complete. Do not forget to sign the form. United States Citizenship and Immigration Services (USCIS) does not accept an unsigned form. Unless instructed to return to the doctor’s office, the doctor provides the medical examination results in a sealed envelope at the end of the appointment. Do not break the seal or open the envelope.

The doctor usually provides a copy of the results for the applicant’s records. This is the only copy the applicant is permitted to open. Where they do not provide a copy automatically, it is generally a good idea to ask for one before they seal the envelope.

Where the applicant is applying from within the United States

The applicant must send the sealed, unopened envelope (which also contains the completed Form I-693) to United States Citizenship and Immigration Services (USCIS) or bring it to the interview, depending, again, on whether the applicant scheduled the medical examination before or after submitting the green card application package (see the scheduling guidance above).

Where the applicant is applying from abroad

The doctor either gives the sealed, unopened envelope (and the X-ray films) to the applicant to bring to the interview, or may send it directly to the US embassy or consulate, depending on the home country’s specific requirements for the medical examination.

Important information for women

All female applicants must complete the medical examination even where they are menstruating.
In addition, pregnant women must have a chest X-ray, where required. However, they must first consent with the doctor and must be given additional protection during the procedure.

Pregnant women may also postpone the X-ray until after the birth, but the X-ray must be completed before entering the United States (where applying from abroad) or before completing the green card application, or Form I-485 (where applying from within the United States).

Health-related grounds of refusal

During the examination, the doctor’s job is to ensure that the relative seeking the green card poses no health threat to current residents of the United States.

The main health-related grounds on which a person may be refused a green card are as follows:

• Communicable diseases:Where the applicant has gonorrhoea, leprosy, syphilis, or active, untreated and infectious tuberculosis, they cannot receive a green card until the disease has been treated and/or cured.
• Drug and alcohol misuse:Where the applicant has a history of drug misuse, they may be required to take a drug test and/or to certify that they have completed a drug treatment programme. Where the applicant is currently misusing prescription medicines, illegal drugs, or alcohol, they are not permitted to receive a green card.
• Mental illness with a history or threat of violence:Where the applicant has a mental illness that has caused violence in the past or is associated with violence, whether towards themselves or others, they may have difficulty obtaining a green card. Under United States Citizenship and Immigration Services (USCIS) policy, drink-driving falls within this category.
• Inability to work:Where the applicant’s health is so poor that they would be unable to support themselves financially, they may be refused a green card on the basis of the likelihood of becoming a “public charge”, essentially a person who is already dependent, or is likely to become dependent at any time in the future, on government benefits. This is likely to apply to a person with a serious degenerative or terminal illness.

Issues that may be accepted

A green card applicant is generally not refused on medical grounds where they:

• Have a cold at the time of the medical examination
• Have a chronic but well-managed illness, such as diabetes or heart disease
• Are HIV positive
• Previously had one of the communicable diseases listed above (and have since been cured)

However, where the relative seeking the green card has a relevant health condition that could lead to their application being refused, it is generally best to do the following:

• Where the applicant has tested positive for gonorrhoea, syphilis, leprosy, or tuberculosis in the past:It is important to show United States Citizenship and Immigration Services (USCIS) or the Department of State that the applicant has been treated successfully. Usually, the best way to do this is to bring copies of medical records showing the treatment received and the outcome of that treatment, as well as a statement from the regular doctor confirming that the applicant’s illness has either been cured or is being managed.
• Where the applicant has any history of drug misuse or mental illness:It is important to bring evidence to the medical examination that the drug addiction has been treated or that mental health is under control.
• Where the applicant has any other potentially serious illness:Good practice is to obtain a letter from the regular doctor explaining how the illness is controlled and how life is affected — including how the illness affects the applicant’s ability to work, if at all.
• Where a green card application is refused on health grounds:The applicant may apply for a “waiver of inadmissibility” (essentially, “forgiveness” from the US government to enter the United States).

United States Citizenship and Immigration Services (USCIS) generally consults the Centers for Disease Control and Prevention (CDC) to determine whether a waiver should be granted. United States Citizenship and Immigration Services (USCIS) may also attach conditions to the grant of a waiver where it sees fit.

For example, an applicant with tuberculosis needs to agree to see a doctor immediately on entering the United States and to arrange to receive treatment. United States Citizenship and Immigration Services (USCIS) may refuse a waiver where the applicant states openly that they are unwilling to receive treatment for their medical condition.