Updated November 11, 2026

Green card interview without a medical exam: Form I-693 rules, exemptions and what happens at the window

Under USCIS rules effective December 2, 2024, you must submit Form I-693 or a required partial Form I-693 with Form I-485, or USCIS may reject your application at filing. If you attend an adjustment of status interview without a valid medical exam on file, or you forget the original civil surgeon envelope after filing online, the officer cannot approve your case that day and issues a Request for Evidence (RFE), a Notice of Intent to Deny (NOID) or a denial. Certain applicants, including qualifying K-1 visa holders, refugees and eligible Afghan nationals, do not have to repeat the full medical examination in the United States.

Why most applicants can no longer wait until the interview to submit Form I-693

For years, adjustment of status applicants often filed Form I-485 first and held onto their medical examination until USCIS sent an RFE or scheduled an in-person interview. That option ended on December 2, 2024.

Under USCIS policy effective December 2, 2024, anyone required to submit Form I-693, or a partial Form I-693 such as the Vaccination Record, must file it together with Form I-485. If you omit Form I-693 from your initial paper Form I-485 package, the USCIS lockbox may reject the entire application.

USCIS adopted this rule because it waives in-person interviews for certain adjustment categories on a case-by-case basis. Submitting complete initial evidence upfront eliminates the need for an officer to issue an RFE and avoids adjudication delays when an interview is waived.

• Filing Form I-485 by mail: Include Form I-693 inside the original sealed envelope provided by the civil surgeon. Do not open or alter this envelope.
• Filing Form I-485 online: If you file Form I-485 online, USCIS requires you to open the sealed envelope from the civil surgeon, upload the completed Form I-693 with your application, and keep the original paper Form I-693 and opened envelope until USCIS decides your case. Bring both to your interview.
• Refiling after a lockbox rejection: If the USCIS lockbox rejects your package (such as for a fee issue or missing signature) and returns your Form I-693 with the envelope opened, you do not need a brand-new medical exam. You may refile using that original opened Form I-693 and its original envelope, as long as you include a copy of the USCIS rejection notice.

What happens if you attend your green card interview without a medical exam?

You can still arrive at a USCIS interview without a complete medical report. This occurs if you filed Form I-485 before December 2, 2024 without Form I-693, filed online and forgot the physical original form and envelope, have missing overseas panel physician records, or the civil surgeon omitted required tests or signatures.

The USCIS Policy Manual notes that applicants bear the burden of proof under Section 291 of the Immigration and Nationality Act to establish they are admissible on health-related grounds. To meet this burden, you must satisfy five criteria: a USCIS-designated civil surgeon must perform the exam under CDC Technical Instructions. Both you and the doctor must sign the accepted form edition. You must submit the form according to form instructions. The results must confirm no Class A condition and full vaccination compliance (unless waived). And the form must remain valid at adjudication.

If any required criterion is missing on interview day, the officer cannot approve your green card on the spot. Under the USCIS Policy Manual, the officer must follow standard operating procedures to issue an RFE, a Notice of Intent to Deny (NOID) or a denial.

Never skip a scheduled interview because your medical results are delayed. Attend on time so the officer can review your other eligibility items and issue an RFE, giving you a formal window to mail the completed sealed envelope.

How USCIS handles missing or incomplete medical documentation at the adjustment stage (USCIS Policy Manual Volume 7, Part A, Chapter 4 and Volume 8, Part B, Chapters 3 and 4)

Who can adjust status without repeating the full medical exam?

Not every adjustment applicant needs a full physical examination from a civil surgeon in the United States. The USCIS Policy Manual (Volume 8, Part B, Chapter 3) lists 18 benefit categories and sets specific rules based on prior overseas exams with Department of State panel physicians.

By our calculation from the USCIS Policy Manual Volume 8, Part B, Chapter 3 applicability table, 5 of the 18 listed benefit categories unconditionally list 'No' for both the medical examination and vaccination requirements. These five categories are applicants seeking derivative refugee or derivative asylee status while in the United States, principal asylum applicants in the United States, Registry applicants, North American Indians entering the United States, and children of returning residents entering the United States or children of U.S. nationals.

Several other categories can rely on an overseas panel physician exam for the physical and laboratory findings, but must still satisfy the vaccination requirement.

• K-1, K-2, K-3 and K-4 nonimmigrants, plus V nonimmigrants: You do not need to repeat the full medical examination if you file Form I-485 within 1 year of your overseas panel physician exam, the exam revealed no Class A condition (or you complied with a conditional waiver), and your vaccination record is complete. If vaccinations were not completed abroad, you must submit a partial Form I-693 (Parts 1 through 5, Part 7, and Part 10, Vaccination Record) signed by a U.S. civil surgeon.
• Refugees adjusting status: You generally do not need to repeat the full exam unless the overseas examination revealed a Class A medical condition. Overseas vaccination sheets cannot be used for adjustment, so every refugee must submit a partial Form I-693 vaccination record completed by a civil surgeon or a state or local health department physician operating under blanket designation.
• Derivative asylees adjusting status: If you were examined abroad by a panel physician, your A-file contains no Class A condition, you show no evidence of acquiring one since entry, and you file Form I-485 within 1 year of eligibility, you do not need a new full exam. You must still submit a partial Form I-693 vaccination record signed by a civil surgeon. Principal asylees examined only in the United States must submit a full Form I-693.
• Certain Afghan nationals under Operation Allies Welcome (OAW): You do not need to repeat the full exam if you completed an exam abroad (Form DS-7794 or Form DS-2054) or at a U.S. government facility with a blanket-designated civil surgeon (Form I-693), your A-file shows no Class A condition, and no evidence indicates you acquired one since. In consultation with the CDC, USCIS considers qualifying OAW exams valid indefinitely for any future benefit request. If vaccinations were not finished abroad, submit a partial Form I-693 vaccination record.

USCIS adjustment interview vs consular immigrant visa interview

Applicants asking about attending an interview without a medical exam often confuse domestic adjustment of status with overseas consular processing. The forms, doctors and procedures are separate.

If you are inside the United States filing Form I-485, your exam must be completed by a USCIS-designated civil surgeon located in the United States (or a qualifying military physician at a Military Treatment Facility for eligible armed forces members, veterans and dependents) and recorded on Form I-693. An overseas panel physician cannot sign Form I-693.

If you are outside the United States applying for an immigrant visa through the Department of State, you must visit an authorized panel physician appointed by the local U.S. embassy or consulate. More than 760 panel physicians worldwide conduct these exams under CDC Technical Instructions and send results on Form DS-7794 or Form DS-2054 directly to the consular section. You cannot use a U.S. civil surgeon for consular processing abroad.

How to respond if the officer issues an RFE for Form I-693

If your Form I-693 has a missing signature, lacks a required test, uses an expired form edition, or shows signs of envelope tampering, the officer issues an RFE for corrective action. The USCIS Policy Manual instructs the officer to return the original Form I-693 to you when possible and keep a copy in the file.

The Policy Manual authorizes your civil surgeon to resolve the deficiency in one of three ways. In every option, the civil surgeon must place the corrected paperwork in a new sealed envelope for you to deliver to USCIS.

• Option 1, Annotate the original form: If USCIS returned your original Form I-693, the civil surgeon annotates the missing or deficient parts directly on that form. Both you and the civil surgeon re-sign and re-date your certifications, and the doctor seals it in a new envelope.
• Option 2, Complete an entirely new Form I-693: The civil surgeon completes a fresh Form I-693 correcting the deficiency. Both of you sign and date it, and the civil surgeon places it in a new sealed envelope.
• Option 3, Complete only deficient sections on a new form: The civil surgeon completes a new Form I-693 containing only the applicant information, the deficient parts, and the civil surgeon certification (with your signature on the applicant certification). The doctor places both the original Form I-693 and the new partial form in a new sealed envelope.

Checklist: 6 steps to check your Form I-693 before your interview day

Use this pre-interview checklist compiled by our team from USCIS instructions and the Policy Manual to verify your medical documents before meeting the officer.

• 1. Confirm your filing method: If you filed Form I-485 online, bring your physical original Form I-693 and the civil surgeon's opened envelope. USCIS may inspect them at your interview.
• 2. Check your personal copy: Keep a copy of Form I-693 before the civil surgeon seals the envelope. Verify that the edition date at the bottom of every page matches (01/20/25 edition if signed July 3, 2025 or later) and that no pages are missing.
• 3. Check the applicant signature: Applicants age 14 and older must sign Form I-693 themselves, unless a legal guardian signs for a mentally incompetent person. For applicants under 14, either the child, a parent or a legal guardian may sign.
• 4. Confirm the doctor's original signature: Outside of military facilities and health departments using government stamps or seals, the civil surgeon must provide an original handwritten signature. Stamped signatures or photocopies are rejected.
• 5. Prepare exemption evidence: If you filed a partial Form I-693 vaccination record as a K visa holder, refugee, derivative asylee or OAW Afghan national, have your overseas exam date ready and prove you filed Form I-485 within your applicable 1-year window.
• 6. Bring lockbox rejection notices: If your Form I-485 was previously rejected at intake and you refiled using an opened civil surgeon envelope, bring a copy of the lockbox rejection notice to show why the seal was broken.

What the USCIS officer may ask about your medical exam at the interview

During an adjustment interview, the officer reviews your Form I-485 answers, confirms your admissibility, and checks that your medical evidence meets statutory standards.

Here are common medical exam questions officers ask, what the officer is checking under the Policy Manual, and how to prepare.

• "You filed Form I-485 online. Do you have the original Form I-693 and the civil surgeon envelope with you?" What the officer is checking: Online filers must retain the physical original Form I-693 and civil surgeon envelope and present them if requested. How to prepare: Keep the physical paper Form I-693 inside the opened civil surgeon envelope in your folder and hand both to the officer.
• "You only submitted vaccination pages. Why didn't you submit a full medical exam?" What the officer is checking: Whether you qualify for an exemption under Volume 8, Part B, Chapter 3 (such as K-1 adjustment within 1 year of an overseas exam or refugee status). How to prepare: State your qualifying category, your overseas panel physician exam date, and that no Class A condition was found.
• "Have you had any health changes or communicable disease diagnoses since the civil surgeon signed your form?" What the officer is checking: Under Volume 8, Part B, Chapter 4, officers have discretion to request further medical evidence or an updated Form I-693 if there is reason to believe your medical condition changed. How to prepare: Answer directly and truthfully. If your health has not changed, state that clearly.
• "Your Form I-693 is missing the doctor's original signature on Part 7. Did you receive a corrected copy?" What the officer is checking: Form I-693 requires an original signature from the civil surgeon. Any deficiency requires an RFE for corrective action. How to prepare: Never write on the form yourself. Request that the officer return the original form with the RFE so your civil surgeon can re-sign it or issue a new sealed envelope.

Practice example

I see you filed Form I-485 online, or you only included the vaccination pages of Form I-693. Do you have your original medical examination envelope or proof that you are exempt from a full exam today?

A strong answer identifies your exact filing situation in one or two direct sentences and presents the correct paperwork. If you filed online, explain that you opened the sealed envelope to upload the required scan, and hand the officer both the original physical Form I-693 and the opened envelope from your folder. If you submitted only the vaccination record, state your qualifying category, such as adjusting from a K-1 visa within 1 year of your overseas panel physician exam, and provide that exam date. If your civil surgeon results are still pending, state your appointment date and ask for an RFE so you can submit the sealed envelope promptly.

The officer is checking whether you have met your legal burden of proof under the USCIS Policy Manual to show admissibility on health-related grounds. Giving the exact date of your prior overseas exam, handing over the original Form I-693 and envelope from an online filing, or clearly asking for an RFE lets the officer document the record without confusion.

This is interview practice, not legal advice. For questions about your own case, talk to an immigration attorney. Visaful is not affiliated with the U.S. government or the Department of State.