Introduction: The Medical Examination Requirement for Adjustment of Status

In order to be eligible for adjustment of status, an applicant must be admissible to the United States. Accordingly, the applicant must not be subject to health-related grounds of inadmissibility. In order to demonstrate that he or she is not inadmissible on health-related grounds, the applicant must undergo a medical examination and submit a Form I-693, Report of Medical Examination and Vaccination Record, completed by a designated civil surgeon. The medical examination is only valid for one year. This article will explain the rules for completing the medical examination requirement for an adjustment of status application. To learn in detail about the health-related grounds of inadmissibility, please read our full article.

Statutory and Regulatory Basis of the Medical Examination Requirement

The requirement for adjustment of status applications to undergo a medical examination by a civil surgeon derives from section 232(b) of the Immigration and Nationality Act (INA). The medical examination is required in order to verify that the alien is not inadmissible under section 212(a)(1)(A) of the INA. Please read our full article about health-related grounds of inadmissibility [see article] to learn more.

This requirement is mirrored in regulations found in 8 C.F.R. 245.5 [PDF version]. The regulation notes that the medical examination is not a requirement for a K visa adjustment applicant who is applying for adjustment of status provided that the medical examination he or she underwent as part of the K visa application process did not occur more than 1 year prior to the application for adjustment of status.

Volume 8, Part B, Chapter 3 of the USCIS Policy Manual (PM) explains that V visa adjustment applicants are subject to the same rules as K visa adjustment applicants. If the initial medical examination revealed a Class A medical condition, a new examination may be required. If the K or V adjustment applicant was granted a conditional waiver, the applicant may submit evidence that he or she complied with the waiver terms. Both K and V adjustment applicants must still comply with the vaccination requirements if the vaccination record was not included with the original medical examination report.

The PM explains that under 8 C.F.R. 209.1(c), a refugee who is applying for adjustment of status generally does not need to repeat the entire medical examination if he or she was examined by a panel physician in order to be admitted to the United States. However, a refugee must undergo an additional medical examination if the original examination revealed a Class A medical condition. Derivative refugees who are granted status in the United States must submit to a medical examination. All refugees must comply with the vaccination requirements to adjust status by submitting the relevant parts of the Form I-693 completed by a designated civil surgeon.

Asylees applying for adjustment [see article] are required to undergo a medical examination. However, an asylee who had a medical examination conducted overseas is not required to undergo a new medical examination in order to adjust status if:

The results of the overseas medical examination are contained in the A-file and no Class A condition was reported;
The asylee has applied for adjustment of status within one year of eligibility to file; and​
​No evidence in the A-file or testimony given at the interview suggests that the asylee ​ has acquired a Class A​ condition after his or her entry into the United States.​

However, even if the asylee is exempt from the medical examination requirement, he or she must still establish compliance with the vaccination requirements by submitting the relevant parts of the Form I-693 completed by a designated civil surgeon.

Guidance in the USCIS Policy Manual

Volume 8, Part B, Chapter 4 of the USCIS PM contains detailed information on the medical examination requirement for adjustment of status.

Who Can Complete the Medical Examination and the Form I-693?

The applicant must submit to a medical examination by a USCIS-designated civil surgeon who will then fill out the required information on the Form I-693. In order to find a civil surgeon to conduct the medical examination, an applicant can visit www.uscis.gov/civilsurgeons. It is important to remember that only a civil surgeon designated by USCIS can complete the Form I-693 to the satisfaction of USCIS.

USCIS has issued a blanket civil surgeon designation to qualifying military physicians to allow them to complete the medical examination and the Form I-693 in limited cases. In order for a military physician to complete the medical examination and the Form I-693, the adjustment of status applicant must be a U.S. armed forces member, veteran, or dependent thereof, and he or she must be eligible to receive medical care at a Military Treatment Facility (MTF). Furthermore, the medical examination must be completed on the premises of an MTF.

USCIS has also given blanket civil surgeon designation to local and state health departments in the United States for purpose of completing the vaccination portion of the Form I-693 for refugees seeking adjustment of status. In order for a health department to qualify, it must have a physician who meets the professional requirements for a civil surgeon.

If a designated civil surgeon is unable to perform a specific medical assessment, he or she must refer the adjustment applicant to another physician. That physician is then required to complete the appropriate section of the Form I-693 after he or she has completed the evaluation. The civil surgeon may not complete the Form I-693 until he or she has received and reviewed the report of the physician who received the referral, and until he or she has completed whatever treatment the physician who received the referral ordered.

Form Requirements

The PM lists the following requirements for a completed Form I-693:

The form must be completed legibly;
All required parts of the form must be completed;
The form must be signed and dated by the designated civil surgeon who conducted the examination;
The form must be signed and dated by the applicant who was examined;
If applicable, the form must be signed and dated by the physicians completing referral evaluations;
The form must still be valid; and
The form must be in a sealed envelope as detailed in the form’s instructions.

Signature Requirements

If the form is submitted is deficient, USCIS may issue a request for evidence (RFE). For this reason, it is important for applicants to submit to all of the medical examination requirements. A civil surgeon may respond to an RFE by annotating the original Form I-693, by completing an entirely new Form I-693 that rectifies the issues noted in the RFE, or by completing certain sections of a new form along with the information in question. The adjustment applicant may return to the original civil surgeon or find a new civil surgeon to correct the form.

The civil surgeon who completed the medical examination is required to sign the Form I-693. He or she must provide an original signature (signature stamps are not acceptable). The civil surgeon may only sign the Form I-693 after the medical examination is completed. The medical examination is not considered completed until any prescribed treatment for a Class A condition has been administered. If the civil surgeon diagnoses a Class A condition and the applicant subsequently refuses treatment, the civil surgeon may annotate the condition but still certify and sign the form. In this case, USCIS will determine whether the applicant is inadmissible, and may ask the applicant to request a waiver if one is available.

Military physicians may either supply a handwritten or stamped signature.

A physician for a health department which has blanket civil surgeon designation to complete the vaccination portion of the Form I-693 may provide a handwritten or stamped signature.

If the applicant is 14 years of age or older, he or she must sign the Form I-693. If the applicant is mentally incompetent, his or her legal guardian may sign instead. If the applicant is under the age of 14, the applicant, a parent, or a legal guardian may sign the Form I-693.

Validity of the Form I-693

In order to satisfy USCIS that the applicant has met the burden of proof required to establish that he or she is free from a medical condition that would cause inadmissibility, the following criteria must be met:

The medical exam was performed by a USCIS-designated civil surgeon in accordance with HHS regulations;
The medical examination report was properly completed;
The medical examination report was submitted to USCIS within 60 days of it being signed by the civil surgeon*;
The benefit application is adjudicated no more than two years after the date the medical examination report was submitted to USCIS*; and
The medical examination report establishes that the applicant does not have a Class A medical condition and has complied with the vaccination requirements or is granted a waiver.

*The USCIS implemented new rules for the validity period of the Form I-693 on November 1, 2018. However, certain Forms I-693 submitted before November 1, 2018 and attached to pending petitions will still retain validity under the prior rules. For a full explanation of the current rules on Form I-693 validity periods, please see our full article on the issue [see article].

It is important to note that the PM manual explains that, generally, the only acceptable version of the Form I-693 is the version in use at the time of the medical examination.

The USCIS notes that it is acceptable to bring a completed Form I-693 to an interview.

Inadmissibility Determination

Chapter 11 of Volume 8 of Part B of the USCIS PM explains how an inadmissibility determination will be made based on the information in the Form I-693.

If the Form I-693 states that the applicant has a “Class A condition,” that constitutes conclusive evidence that the applicant is inadmissible. Furthermore, a Class A annotation may indicate that the applicant could be subject to other grounds of inadmissibility (e.g., the PM notes that “harmful behavior” associated with a physical or mental disorder, or illegal drug use, may have resulted from criminal convictions that would render the applicant inadmissible). However, the PM explains that a criminal conviction should be supported by criminal records or similar evidence, and not solely by the Form I-693.

If the civil surgeon annotates a “Class B condition” on the Form I-693, the applicant is not inadmissible on health-related grounds. However, a Class B condition may indicate that the applicant is inadmissible on other grounds, such as the public charge ground of inadmissibility.

If the form is not properly completed, USCIS may issue an RFE. In this event, a satisfactory response to the RFE is necessary for the applicant to meet the burden of demonstrating that he or she is not inadmissible on health-related grounds.

Conclusion: The Medical Examination Requirement for Adjustment of Status

The medical examination requirement is a necessary part of an adjustment of status application. This is because the burden is on the applicant for adjustment of status to demonstrate that he or she is not inadmissible on health-related grounds. For this reason, it is essential that for the applicant to complete each part of the medical examination requirement.

An experienced immigration attorney will be able to help the applicant complete the Form I-693 requirement in the most expeditious manner based on the circumstances of his or her adjustment of status application. Furthermore, an experienced immigration attorney can assist an applicant who has health concerns which may call into question his or her admissibility to the United States.

To learn about conditions that can cause inadmissibility for health-related grounds, please read our full article.